Provider Demographics
NPI:1619258324
Name:SLATTERY, CAROL ANN (EDD, LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:EDD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75A LAKE RD STE 132
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2323
Mailing Address - Country:US
Mailing Address - Phone:845-825-1199
Mailing Address - Fax:
Practice Address - Street 1:620 ROUTE 303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1170
Practice Address - Country:US
Practice Address - Phone:845-353-2730
Practice Address - Fax:845-353-2358
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0784661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical