Healthcare Provider Details

I. General information

NPI: 1891650446
Provider Name (Legal Business Name): MARTHA CARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CONTINUUM DR STE 1A
LIVERPOOL NY
13088-4387
US

IV. Provider business mailing address

21 CHURCH ST
PULASKI NY
13142-4406
US

V. Phone/Fax

Practice location:
  • Phone: 315-450-4898
  • Fax: 315-449-9898
Mailing address:
  • Phone: 315-450-4898
  • Fax: 315-449-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number1443427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: