Healthcare Provider Details

I. General information

NPI: 1083007751
Provider Name (Legal Business Name): CAROLYN INAMURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NEW KARNER RD STE 3
ALBANY NY
12205-3840
US

IV. Provider business mailing address

346 CONEY ISLAND AVE APT 704
BROOKLYN NY
11218-1803
US

V. Phone/Fax

Practice location:
  • Phone: 929-379-6989
  • Fax:
Mailing address:
  • Phone: 614-804-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: