Provider Demographics
NPI:1447977012
Name:BRANDT, CAROLYN ANN (MHC)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHC
Mailing Address - Street 1:9 CRISTIN CT
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3018
Mailing Address - Country:US
Mailing Address - Phone:845-786-7199
Mailing Address - Fax:
Practice Address - Street 1:9 CRISTIN CT
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-3018
Practice Address - Country:US
Practice Address - Phone:845-786-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118457-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health