Provider Demographics
NPI:1821246448
Name:CARVILLE, CHRISTINE BETH (LCSW-R)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BETH
Last Name:CARVILLE
Suffix:
Gender:F
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 1:496 JOHN JOY RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-2245
Mailing Address - Country:US
Mailing Address - Phone:917-674-3421
Mailing Address - Fax:
Practice Address - Street 1:496 JOHN JOY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-2245
Practice Address - Country:US
Practice Address - Phone:917-674-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72075527104100000X
NY0779531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW01882Medicare PIN