Provider Demographics
NPI:1093024283
Name:CAROTHERS, KRISTIN JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:JOY
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 BROADWAY, 6TH FL NORTH
Mailing Address - Street 2:PEDIATRIC PSYCHIATRY SCHOOL BASED MENTAL HEALTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030
Mailing Address - Country:US
Mailing Address - Phone:773-307-5572
Mailing Address - Fax:
Practice Address - Street 1:308 WEST 140TH STREET
Practice Address - Street 2:#4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:347-879-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020024-1103TC0700X
NY020024103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent