Healthcare Provider Details

I. General information

NPI: 1063668663
Provider Name (Legal Business Name): CAROLYN LAVON HARVEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

1 HEALTHY WAY ATTN: PHYSICIAN BILLING
OCEANSIDE NY
11572-1551
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3248
  • Fax:
Mailing address:
  • Phone: 516-255-1616
  • Fax: 516-255-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400486
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: