Provider Demographics
NPI:1235357492
Name:ERTEL, CAROL C (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:C
Last Name:ERTEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:ERTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:799 BROADWAY
Mailing Address - Street 2:SUITE 631
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6811
Mailing Address - Country:US
Mailing Address - Phone:212-979-6760
Mailing Address - Fax:
Practice Address - Street 1:799 BROADWAY
Practice Address - Street 2:SUITE 631
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6811
Practice Address - Country:US
Practice Address - Phone:212-979-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-045532102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1091471OtherOXFORD
NYN1J011Medicare PIN