Healthcare Provider Details

I. General information

NPI: 1104755156
Provider Name (Legal Business Name): CARINA SCIVOLETTE MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JERICHO TPKE STE 103
JERICHO NY
11753-1317
US

IV. Provider business mailing address

101 FERRIS LN
POUGHKEEPSIE NY
12603-4127
US

V. Phone/Fax

Practice location:
  • Phone: 516-399-5373
  • Fax:
Mailing address:
  • Phone: 716-345-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: