Provider Demographics
NPI:1295345411
Name:CARMAN, JACQUELYN ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:ANN
Last Name:CARMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:ANN
Other - Last Name:LAKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2621 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6216
Mailing Address - Country:US
Mailing Address - Phone:315-941-0221
Mailing Address - Fax:
Practice Address - Street 1:2621 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6216
Practice Address - Country:US
Practice Address - Phone:315-570-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker