Provider Demographics
NPI:1841200615
Name:CARROLL-BARBUTO, JOHN FRANKLIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANKLIN
Last Name:CARROLL-BARBUTO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:FRANKLIN
Other - Last Name:BARBUTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:32 BENNETT TER
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2936
Mailing Address - Country:US
Mailing Address - Phone:518-369-2148
Mailing Address - Fax:
Practice Address - Street 1:1 BURHANS PL
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1201
Practice Address - Country:US
Practice Address - Phone:518-369-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0695821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069582OtherLICENSE NUMBER