Provider Demographics
NPI:1669570602
Name:BORIS, CAROLYN ROUNDS (LCSW-R)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ROUNDS
Last Name:BORIS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:ROUNDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:301 BRIARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1540
Mailing Address - Country:US
Mailing Address - Phone:845-255-2617
Mailing Address - Fax:845-256-0868
Practice Address - Street 1:301 BRIARWOOD CT
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1540
Practice Address - Country:US
Practice Address - Phone:845-255-2617
Practice Address - Fax:845-256-0868
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025276-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0065022OtherGHI/VALUE OPITONS
NYP531159OtherOXFORD
NY11237602OtherCAQH
NYN24643Medicare ID - Type Unspecified