Healthcare Provider Details

I. General information

NPI: 1053203638
Provider Name (Legal Business Name): CAROLINE HEHIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LOG RD
PATCHOGUE NY
11772-1524
US

IV. Provider business mailing address

22 LOG RD
PATCHOGUE NY
11772-1524
US

V. Phone/Fax

Practice location:
  • Phone: 347-749-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: