Provider Demographics
NPI:1649991571
Name:VAN SCHAICK, CARRIE ALLISON
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ALLISON
Last Name:VAN SCHAICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MILLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-1431
Mailing Address - Country:US
Mailing Address - Phone:646-319-2315
Mailing Address - Fax:
Practice Address - Street 1:205 MILLWOOD RD
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-1431
Practice Address - Country:US
Practice Address - Phone:646-319-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012711-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health