Provider Demographics
NPI:1831284413
Name:ALTMAN, CAROLYN RUTH (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:RUTH
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TERRACE PLACE #2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1014
Mailing Address - Country:US
Mailing Address - Phone:718-871-5852
Mailing Address - Fax:
Practice Address - Street 1:583 5TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-219-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046561-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3157006OtherOXFORD HEALTH PLANS
NYP-12039540OtherMULTIPLAN
NY177894OtherELDERPLAN
NY523596OtherVALUE OPTIONS
NYN2T581Medicare ID - Type Unspecified