Provider Demographics
NPI:1932320306
Name:NACK, CAROL SCHARMAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SCHARMAN
Last Name:NACK
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 1:2 BAY CLUB DR STE E21C
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2917
Mailing Address - Country:US
Mailing Address - Phone:718-631-9686
Mailing Address - Fax:
Practice Address - Street 1:2 BAY CLUB DR STE E21C
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2917
Practice Address - Country:US
Practice Address - Phone:718-631-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0250651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04715Medicare PIN