Provider Demographics
NPI:1427196104
Name:VINSON, CAROL F (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:F
Last Name:VINSON
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 1:262 HENRY STREET
Mailing Address - Street 2:BASEMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4608
Mailing Address - Country:US
Mailing Address - Phone:718-624-4589
Mailing Address - Fax:
Practice Address - Street 1:262 HENRY ST
Practice Address - Street 2:BASEMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4608
Practice Address - Country:US
Practice Address - Phone:718-624-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical