Provider Demographics
NPI:1518096585
Name:KINDOS-CARBERRY, PAULA JAYNE (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JAYNE
Last Name:KINDOS-CARBERRY
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:286 WITTENBERG ROAD
Mailing Address - City:BEARSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12409-0137
Mailing Address - Country:US
Mailing Address - Phone:845-679-5249
Mailing Address - Fax:
Practice Address - Street 1:286 WITTENBERG ROAD
Practice Address - Street 2:
Practice Address - City:BEARSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12409-0137
Practice Address - Country:US
Practice Address - Phone:845-679-5249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025774-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical