Provider Demographics
NPI:1427406545
Name:LEROY, CAROLYN PLUM (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:PLUM
Last Name:LEROY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:PLUM
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:442 MALDEN TPKE
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-5017
Mailing Address - Country:US
Mailing Address - Phone:518-871-3581
Mailing Address - Fax:
Practice Address - Street 1:442 MALDEN TPKE
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-5017
Practice Address - Country:US
Practice Address - Phone:518-871-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089721104100000X
NY0853441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker