Provider Demographics
NPI:1780767889
Name:DONLEY, CAROLYN (LCSW R)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:DONLEY
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PIKE STREET
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771
Mailing Address - Country:US
Mailing Address - Phone:845-858-1456
Mailing Address - Fax:845-858-1459
Practice Address - Street 1:30 HARRIMAN DRIVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-291-2600
Practice Address - Fax:845-291-2628
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0743311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N578L1Medicare ID - Type Unspecified