Provider Demographics
NPI:1144377862
Name:ATWATER, CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:ATWATER
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 1:945 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3649
Mailing Address - Country:US
Mailing Address - Phone:518-383-8889
Mailing Address - Fax:518-383-8881
Practice Address - Street 1:945 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3649
Practice Address - Country:US
Practice Address - Phone:518-383-8889
Practice Address - Fax:518-383-8881
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011449OtherNYS LICENSE #
NY01627114Medicaid
NY000407006007Medicare UPIN
NY350253Medicare UPIN
NY01627114Medicaid
NY99681Medicare UPIN
NY011449OtherNYS LICENSE #
NY10000068Medicare UPIN
NYV02391Medicare UPIN