Healthcare Provider Details

I. General information

NPI: 1982929071
Provider Name (Legal Business Name): DEBORAH MARY CARNEY RN NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 12/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 MIDDLE COUNTRY RD SUITE 4
CENTEREACH NY
11720
US

IV. Provider business mailing address

2539 MIDDLE COUNTRY RD SUITE 4
CENTEREACH NY
11720
US

V. Phone/Fax

Practice location:
  • Phone: 631-737-6434
  • Fax:
Mailing address:
  • Phone: 631-737-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number384611-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: