Provider Demographics
NPI:1558428623
Name:YANCEY, CAROL L (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:YANCEY
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 POST RD
Mailing Address - Street 2:SUITE A-18
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6015
Mailing Address - Country:US
Mailing Address - Phone:203-292-6398
Mailing Address - Fax:203-283-0532
Practice Address - Street 1:1275 POST RD
Practice Address - Street 2:SUITE A-18
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6060
Practice Address - Country:US
Practice Address - Phone:203-292-6398
Practice Address - Fax:203-283-0532
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT061451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11511870OtherCAQH