| Doctor Name: | DR. CAROLYN GRACE PEABODY |
| NPI Number: | 1902061997 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D., L.C.S.W. |
| License Number: | R038969-1 |
| Business Practice Address: | 53840 Main Rd Southold, NY - 119714625 |
| Business Phone Number: | 6313231333 |
| Business Fax Number: | 6313233824 |
| Mailing Address: | 970 Greenway E, ORIENT |
| State: | NY |
| Postal Code: | 119571314 |
| Phone Number: | 6313231333 |
| Fax Number: | 6313233824 |
| NPI Enumeration Date: | 07/19/2008 |
| NPI Last Update Date: | 07/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R038969-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |