Healthcare Provider Details

I. General information

NPI: 1538095641
Provider Name (Legal Business Name): CARLY A MCMANN MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 SMITH ST
LINDENHURST NY
11757-5020
US

IV. Provider business mailing address

490 S 6TH ST
LINDENHURST NY
11757-4635
US

V. Phone/Fax

Practice location:
  • Phone: 631-478-7301
  • Fax:
Mailing address:
  • Phone: 631-987-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP133908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: