Provider Demographics
NPI:1437162567
Name:GARVEY-GORDON, CAROLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GARVEY-GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 OLD COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1115
Mailing Address - Country:US
Mailing Address - Phone:516-365-7858
Mailing Address - Fax:516-365-3526
Practice Address - Street 1:425 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1115
Practice Address - Country:US
Practice Address - Phone:516-365-7858
Practice Address - Fax:516-365-3526
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02759111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0069364OtherGHI PROVIDER ID
NY76086949OtherUNITED HEALTHCARE
NY108741OtherMHN PROVIDER ID
NY049971000OtherMAGELLAN MIS #
NY22162OtherVYTRA PROVIDER ID
NY0005088691OtherAETNA PROVIDER ID
NY112794161OtherCIGNA PROVIDER ID
NYAS138OtherOXFORD
NYN13721OtherEMPIRE BCBS
NY025204OtherVALUEOPTIONS PROVIDER ID
NY22162OtherVYTRA PROVIDER ID