Provider Demographics
NPI:1174627210
Name:SUTTON, CAROLYN FRIED (PSYD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FRIED
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PSYD
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 1155
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1155
Mailing Address - Country:US
Mailing Address - Phone:845-256-7004
Mailing Address - Fax:
Practice Address - Street 1:52 S MANHEIM BLVD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2406
Practice Address - Country:US
Practice Address - Phone:845-256-7004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011284-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY351400000OtherMAGELLAN
NYV677FOtherEMP BC BS NSLIJ HOSP
NY7349256OtherGHI
NYP3617311OtherOXFORD
NY144604OtherVALUE OPTIONS
NYV1J44OtherEMP BL CROSS BL SHIELD
NY04920Medicare ID - Type UnspecifiedNEW YORK CITY