Healthcare Provider Details

I. General information

NPI: 1467945675
Provider Name (Legal Business Name): CARMEN I CARRION PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE LOWR LEVEL
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

16 ARROWHEAD LN
BRANFORD CT
06405-3906
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-7410
  • Fax:
Mailing address:
  • Phone: 718-530-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number022650
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3772
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: