Provider Demographics
NPI:1972037224
Name:CARLILE, TAMMY (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:CARLILE
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 1:310 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-5222
Mailing Address - Country:US
Mailing Address - Phone:845-247-6500
Mailing Address - Fax:458-246-4103
Practice Address - Street 1:310 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-5222
Practice Address - Country:US
Practice Address - Phone:845-247-6500
Practice Address - Fax:845-246-4103
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0863011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool