Provider Demographics
NPI:1043221427
Name:WHITNEY, CAROLYN GIBBS (MSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:GIBBS
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 COUNTY ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-2718
Mailing Address - Country:US
Mailing Address - Phone:518-642-2708
Mailing Address - Fax:518-642-3988
Practice Address - Street 1:1177 COUNTY ROUTE 23
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-2718
Practice Address - Country:US
Practice Address - Phone:518-642-2708
Practice Address - Fax:518-642-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027330-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56143-BMedicare ID - Type UnspecifiedMEDICARE ID.