Provider Demographics
NPI:1962651992
Name:MAGEE, CAROL S (LCSW CASAC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:MAGEE
Suffix:
Gender:F
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-2835
Mailing Address - Country:US
Mailing Address - Phone:631-287-3779
Mailing Address - Fax:631-287-2090
Practice Address - Street 1:450 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2835
Practice Address - Country:US
Practice Address - Phone:631-287-3779
Practice Address - Fax:631-287-2090
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical