Provider Demographics
NPI:1770829459
Name:ANDERSEN, CAROLYN A (TSHH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOLCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1426
Mailing Address - Country:US
Mailing Address - Phone:518-585-6867
Mailing Address - Fax:
Practice Address - Street 1:16 HOLCOMB AVE
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1426
Practice Address - Country:US
Practice Address - Phone:518-585-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist