Provider Demographics
NPI:1245382308
Name:ATHEY, CAROL FREEMAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:FREEMAN
Last Name:ATHEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:FREEMAN-ATHEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2520 LONGVIEW ST
Mailing Address - Street 2:#312
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4250
Mailing Address - Country:US
Mailing Address - Phone:512-473-2599
Mailing Address - Fax:512-473-2499
Practice Address - Street 1:2520 LONGVIEW ST
Practice Address - Street 2:#312
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4250
Practice Address - Country:US
Practice Address - Phone:512-473-2599
Practice Address - Fax:512-473-2499
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX098921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0S76PMedicare UPIN