Provider Demographics
NPI:1013094465
Name:ANTLER, CAROL J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:ANTLER
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 1:20 E 68TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5867
Mailing Address - Country:US
Mailing Address - Phone:212-737-2010
Mailing Address - Fax:
Practice Address - Street 1:20 E 68TH ST STE 206
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5867
Practice Address - Country:US
Practice Address - Phone:212-737-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047156OtherNYS LINCENSE
NYCA0NF560100Medicare UPIN