MEDICARE: DR. JEFFREY A CARMEN PH. D.

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	103TB0200X	Cognitive & Behavioral Psychologist	5908	NY

General Provider Information

NPI Number	:	1265427512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A CARMEN PH. D.

Provider Business Mailing Address
First Line	:	4016 HENNEBERRY RD
Second Line	:
City	:	MANLIUS
State	:	NY
Zip	:	13104-8532
Country	:	US
Telephone Number	:	315-682-5272
Fax Number	:	315-682-4716

Provider Business Practice Location Address
First Line	:	4016 HENNEBERRY RD
Second Line	:
City	:	MANLIUS
State	:	NY
Zip	:	13104-8532
Country	:	US
Telephone Number	:	315-682-5272
Fax Number	:	315-682-4716

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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