Provider Demographics
NPI:1487067054
Name:DAVIDSON, CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:DAVIDSON
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 1:3404 OCEAN AVE
Mailing Address - Street 2:C2
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1573
Mailing Address - Country:US
Mailing Address - Phone:516-593-5251
Mailing Address - Fax:
Practice Address - Street 1:3404 OCEAN AVE
Practice Address - Street 2:C2
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1573
Practice Address - Country:US
Practice Address - Phone:516-593-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0713521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical