Healthcare Provider Details

I. General information

NPI: 1508987405
Provider Name (Legal Business Name): JAMES CARNELIA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E 11TH ST FL 4 C-O WASHINGTON SQUARE INSTITUTE
NEW YORK NY
10003-4602
US

IV. Provider business mailing address

38 E 81ST ST SUITE #5-B
NEW YORK NY
10028-0216
US

V. Phone/Fax

Practice location:
  • Phone: 212-472-5974
  • Fax:
Mailing address:
  • Phone: 212-472-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number009994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: