Healthcare Provider Details

I. General information

NPI: 1861144230
Provider Name (Legal Business Name): KRYSTLE MARIE CARPENTER LMHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EXECUTIVE BLVD STE 178
YONKERS NY
10701-6836
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 914-595-1482
  • Fax: 914-265-8937
Mailing address:
  • Phone: 845-795-5908
  • Fax: 845-622-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013312
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP112367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: