Provider Demographics
NPI:1174533079
Name:POHRILLE, CAROL RENEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:RENEE
Last Name:POHRILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1403
Mailing Address - Country:US
Mailing Address - Phone:516-674-2445
Mailing Address - Fax:516-674-0255
Practice Address - Street 1:105 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1403
Practice Address - Country:US
Practice Address - Phone:516-674-2445
Practice Address - Fax:516-674-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027473-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY062656OtherVALUE OPTIONS
NY062656OtherVYTRA
NY6899895OtherGHI
NY027473OtherHIP
NY4313169OtherAETNA
NY115430000OtherMAGELLAN
NYP2534366OtherOXFORD
NY01526609Medicaid
NYN73791OtherBCBS
NY76715OtherUBH
NYN73791Medicare PIN