Provider Demographics
NPI:1295810075
Name:SPIVACK, CAROLE HALPERT (LCSW-R)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:HALPERT
Last Name:SPIVACK
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 1:125 LARCHMONT AVE
Mailing Address - Street 2:3F
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3761
Mailing Address - Country:US
Mailing Address - Phone:212-920-6019
Mailing Address - Fax:914-315-6369
Practice Address - Street 1:425 E 86TH ST
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-6449
Practice Address - Country:US
Practice Address - Phone:212-920-6019
Practice Address - Fax:914-315-6369
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0456711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND91606371Medicare PIN