Provider Demographics
NPI:1245561539
Name:ADAMSON, CAROL LILIETH (MA)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LILIETH
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3301
Mailing Address - Country:US
Mailing Address - Phone:347-575-7698
Mailing Address - Fax:
Practice Address - Street 1:1119 E 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3301
Practice Address - Country:US
Practice Address - Phone:347-575-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities