Provider Demographics
NPI:1760406433
Name:GURIN, CAROL (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GURIN
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 1:39 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6437
Mailing Address - Country:US
Mailing Address - Phone:914-391-4861
Mailing Address - Fax:
Practice Address - Street 1:910 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3533
Practice Address - Country:US
Practice Address - Phone:212-851-8100
Practice Address - Fax:212-932-0964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02200099Medicaid
NY02200099Medicaid