Healthcare Provider Details

I. General information

NPI: 1952475360
Provider Name (Legal Business Name): CAROLYN M YEAGER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 COMMACK RD SUITE 100
COMMACK NY
11725-3400
US

IV. Provider business mailing address

283 COMMACK RD SUITE 100
COMMACK NY
11725-3400
US

V. Phone/Fax

Practice location:
  • Phone: 631-462-1032
  • Fax: 631-462-5620
Mailing address:
  • Phone: 631-462-1032
  • Fax: 631-462-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: