Healthcare Provider Details

I. General information

NPI: 1255330841
Provider Name (Legal Business Name): JUDITH BAMBERGER-CARROLL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 CRESTWOOD RD
WOODMERE NY
11598-1633
US

IV. Provider business mailing address

1025 CRESTWOOD RD
WOODMERE NY
11598-1633
US

V. Phone/Fax

Practice location:
  • Phone: 516-569-6828
  • Fax: 516-569-6828
Mailing address:
  • Phone: 516-569-6828
  • Fax: 516-569-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number015245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: