Healthcare Provider Details

I. General information

NPI: 1194672204
Provider Name (Legal Business Name): IRIS JADE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORPORATE DR
PEEKSKILL NY
10566-1810
US

IV. Provider business mailing address

PO BOX 162
VERPLANCK NY
10596-0162
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-0191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number41389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: