MEDICARE: CAROLYN CANTOR LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	120455-01	NY

General Provider Information

NPI Number	:	1932928736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN CANTOR LMSW

Provider Business Mailing Address
First Line	:	412 6TH AVE STE 602
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8409
Country	:	US
Telephone Number	:	646-554-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 W 24TH ST APT 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-1742
Country	:	US
Telephone Number	:	646-554-5005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	10/08/2024

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Directions to “ CAROLYN CANTOR LMSW” Practice Location

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