Healthcare Provider Details

I. General information

NPI: 1881165983
Provider Name (Legal Business Name): KRISTEN E CAROPRESE LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MILLER RD
MAHOPAC NY
10541-2220
US

IV. Provider business mailing address

18 MILLER RD
MAHOPAC NY
10541-2220
US

V. Phone/Fax

Practice location:
  • Phone: 845-628-2300
  • Fax: 845-845-7800
Mailing address:
  • Phone: 845-628-2300
  • Fax: 845-845-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN CAROPRESE
Title or Position: OWNER
Credential:
Phone: 845-628-2300