Healthcare Provider Details

I. General information

NPI: 1386847044
Provider Name (Legal Business Name): CAROLE BETH OKUN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 VAN DAM ST 2ND FLOOR
NEW YORK NY
10013
US

IV. Provider business mailing address

501 RIVERDALE AVE APT 3J
YONKERS NY
10705-3583
US

V. Phone/Fax

Practice location:
  • Phone: 212-366-8040
  • Fax: 212-366-8144
Mailing address:
  • Phone: 914-968-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR055184-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: