Provider Demographics
NPI:1356623797
Name:CLARK-TENNEY, CAROLYN ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANNE
Last Name:CLARK-TENNEY
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 1:77 POUND RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-1235
Mailing Address - Country:US
Mailing Address - Phone:914-474-5377
Mailing Address - Fax:
Practice Address - Street 1:77 POUND RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1235
Practice Address - Country:US
Practice Address - Phone:914-474-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072038-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker