Healthcare Provider Details

I. General information

NPI: 1922864651
Provider Name (Legal Business Name): LILLIAN CARNERO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HAMBURG TPKE STE 302
WAYNE NJ
07470-2139
US

IV. Provider business mailing address

401 HAMBURG TPKE STE 302
WAYNE NJ
07470-2139
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-9222
  • Fax:
Mailing address:
  • Phone: 973-790-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ14975500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: