Provider Demographics
NPI:1447354188
Name:SCHWARTZ, CAROLYN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:SCHWARTZ
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:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0016
Mailing Address - Country:US
Mailing Address - Phone:631-751-5207
Mailing Address - Fax:631-476-0766
Practice Address - Street 1:178 CHRISTIAN AVE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1216
Practice Address - Country:US
Practice Address - Phone:631-751-5207
Practice Address - Fax:631-476-0766
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003917-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical