Provider Demographics
NPI:1700979036
Name:POSSIN, CAROL C (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:C
Last Name:POSSIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1427
Mailing Address - Country:US
Mailing Address - Phone:518-370-2679
Mailing Address - Fax:
Practice Address - Street 1:2361 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1427
Practice Address - Country:US
Practice Address - Phone:518-370-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist