Healthcare Provider Details

I. General information

NPI: 1194192880
Provider Name (Legal Business Name): CARRIE LYNN GEORGE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE LYNN CITRIN PMHNP

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRAL NEW YORK PSYCHIATRIC CENTER 9005 OLD RIVER RD.
MARCY NY
13403
US

IV. Provider business mailing address

CENTRAL NEW YORK PSYCHIATRIC CENTER 9005 OLD RIVER RD. (PO BOX 300)
MARCY NY
13403
US

V. Phone/Fax

Practice location:
  • Phone: 315-765-3600
  • Fax: 315-765-3629
Mailing address:
  • Phone: 315-765-3660
  • Fax: 315-765-3629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401893
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: