Provider Demographics
NPI:1144421926
Name:ETHAN, CAROL B (MA, NCPSYA, NYS000)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:B
Last Name:ETHAN
Suffix:
Gender:F
Credentials:MA, NCPSYA, NYS000
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W. 76TH ST.
Mailing Address - Street 2:14C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8217
Mailing Address - Country:US
Mailing Address - Phone:212-595-4657
Mailing Address - Fax:212-595-4657
Practice Address - Street 1:235 W. 76TH ST.
Practice Address - Street 2:14C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8217
Practice Address - Country:US
Practice Address - Phone:212-595-4657
Practice Address - Fax:212-595-4657
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000376102L00000X
NYNYS000376102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPSYAP041648OtherNATL ASSN ADVANCEMENT PSYCHO ANALYSIS
P041648OtherNAAP