Provider Demographics
NPI:1588658769
Name:CARENTZ, WILLIAM G (LCSW R)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:CARENTZ
Suffix:
Gender:M
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1866
Mailing Address - Country:US
Mailing Address - Phone:607-432-1180
Mailing Address - Fax:607-432-0032
Practice Address - Street 1:48 DIETZ ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1866
Practice Address - Country:US
Practice Address - Phone:607-432-1180
Practice Address - Fax:607-432-0032
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02773411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3186263OtherVALUE OPTIONS
NY52179OtherMOHAWK VALLEY PHYSICIANS
137717OtherMHS
NYP00151157OtherMEDICARE RAILROAD
NY53434BMedicare ID - Type Unspecified