Provider Demographics
NPI:1720146814
Name:CAROFF, PHYLLIS (MSW DSW LCSW)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:CAROFF
Suffix:
Gender:F
Credentials:MSW DSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WEST 81ST STREET
Mailing Address - Street 2:APT 8F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6022
Mailing Address - Country:US
Mailing Address - Phone:212-787-6135
Mailing Address - Fax:212-362-4975
Practice Address - Street 1:15 WEST 81ST STREET
Practice Address - Street 2:APT 8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6022
Practice Address - Country:US
Practice Address - Phone:212-787-6135
Practice Address - Fax:212-362-4975
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00089411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN09381Medicare ID - Type Unspecified