Provider Demographics
NPI:1538286943
Name:CARR, ROBERT GARVY SR (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GARVY
Last Name:CARR
Suffix:SR
Gender:M
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:BOX 314
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13431
Mailing Address - Country:US
Mailing Address - Phone:315-826-3683
Mailing Address - Fax:315-826-3683
Practice Address - Street 1:8917 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:NY
Practice Address - Zip Code:13431
Practice Address - Country:US
Practice Address - Phone:315-826-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031475-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01991464Medicaid
NY55990BMedicare ID - Type Unspecified