Provider Demographics
NPI:1093922825
Name:MCNALLY, CAROL R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:R
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5188
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0188
Mailing Address - Country:US
Mailing Address - Phone:631-796-3858
Mailing Address - Fax:
Practice Address - Street 1:150 MOTOR PKWY
Practice Address - Street 2:STE 401
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5108
Practice Address - Country:US
Practice Address - Phone:631-796-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077501-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical