Provider Demographics
| NPI: | 1124247283 |
|---|---|
| Name: | FREEMAN-CARROLL, NANCY MINA (PSYD) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | NANCY |
| Middle Name: | MINA |
| Last Name: | FREEMAN-CARROLL |
| Suffix: | |
| Gender: | F |
| Credentials: | PSYD |
| Other - Prefix: | DR |
| Other - First Name: | NANCY |
| Other - Middle Name: | MINA |
| Other - Last Name: | FREEMAN |
| Other - Suffix: | |
| Other - Last Name Type: | Professional Name |
| Other - Credentials: | PSYD |
| Mailing Address - Street 1: | 350 CENTRAL PARK W |
| Mailing Address - Street 2: | 13E |
| Mailing Address - City: | NEW YORK |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 10025-6547 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 212-665-0442 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 350 CENTRAL PARK W |
| Practice Address - Street 2: | 13E |
| Practice Address - City: | NEW YORK |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 10025-6547 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 212-665-0442 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2007-04-25 |
| Last Update Date: | 2011-01-26 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NY | 012527-1 | 103T00000X, 103TA0400X, 103TA0700X, 103TC0700X, 103TF0000X, 103TF0200X, 103TH0100X, 103TM1800X, 103TP0814X, 103TP2701X, 103TS0200X |
| NY | 012527-01 | 103TC1900X, 103TC2200X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic |
| No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
| No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | V30261 | Medicare ID - Type Unspecified | CLINICAL PSYCHOLOGIST |
