Provider Demographics
NPI:1750303921
Name:CAROL, GENATA (PHD)
Entity Type:Individual
Prefix:MS
First Name:GENATA
Middle Name:
Last Name:CAROL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E 11TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4602
Mailing Address - Country:US
Mailing Address - Phone:212-645-0875
Mailing Address - Fax:212-645-0705
Practice Address - Street 1:41 E 11TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:212-645-0875
Practice Address - Fax:212-645-0705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP52004Medicare UPIN
NYVL6101Medicare ID - Type Unspecified