Healthcare Provider Details

I. General information

NPI: 1164894283
Provider Name (Legal Business Name): CORINNE CAUFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GARFIELD AVE
EAST ISLIP NY
11730-1114
US

IV. Provider business mailing address

4 PANDORA DR
BRENTWOOD NY
11717-1912
US

V. Phone/Fax

Practice location:
  • Phone: 631-332-4613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008154-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: