Healthcare Provider Details

I. General information

NPI: 1740821669
Provider Name (Legal Business Name): CAROLYN FAY CERTILMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5908
  • Fax: 845-279-5447
Mailing address:
  • Phone: 845-279-5908
  • Fax: 845-279-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number023280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: