Provider Demographics
NPI:1508014135
Name:WILLIAMS, CARLTON BRYANT (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:BRYANT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1623
Mailing Address - Country:US
Mailing Address - Phone:845-255-3046
Mailing Address - Fax:845-255-0236
Practice Address - Street 1:16 E 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3105
Practice Address - Country:US
Practice Address - Phone:212-206-5200
Practice Address - Fax:212-206-5279
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017763103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling