Provider Demographics
NPI:1326012626
Name:STEVENS, CAROL A (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W 72ND ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3329
Mailing Address - Country:US
Mailing Address - Phone:212-496-5555
Mailing Address - Fax:212-496-5555
Practice Address - Street 1:166 W 72ND ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3329
Practice Address - Country:US
Practice Address - Phone:212-496-5555
Practice Address - Fax:212-496-5555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0254631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01588449Medicaid
NYN44591Medicare ID - Type Unspecified