Healthcare Provider Details

I. General information

NPI: 1639013741
Provider Name (Legal Business Name): CAROLINE SEVERE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7716 KENNEDY BLVD APT 1E
NORTH BERGEN NJ
07047-4181
US

IV. Provider business mailing address

8947 PONTIAC ST
QUEENS VILLAGE NY
11427-2731
US

V. Phone/Fax

Practice location:
  • Phone: 646-573-6643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NR25401500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: