Healthcare Provider Details

I. General information

NPI: 1063975035
Provider Name (Legal Business Name): CARLA HAYLEY HEYWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MARCUS GARVEY BLVD STE 420
BROOKLYN NY
11206-5303
US

IV. Provider business mailing address

7 MARCUS GARVEY BLVD STE 420
BROOKLYN NY
11206-5303
US

V. Phone/Fax

Practice location:
  • Phone: 917-966-5255
  • Fax: 917-966-5254
Mailing address:
  • Phone: 917-966-5255
  • Fax: 917-966-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: