Healthcare Provider Details

I. General information

NPI: 1528378601
Provider Name (Legal Business Name): AMANDA NICOLE CARRERA-ALVAREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY, DEPARTMENT OF PSYCHIATRY WOODHULL MEDICAL & MENTAL HEALTH CENTER
BROOKLYN NY
11206
US

IV. Provider business mailing address

PO BOX 24449
NEW YORK NY
10087-0589
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax:
Mailing address:
  • Phone: 833-351-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0074198
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number275750
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number275750
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: