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General NPI Number Information
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NPI Number | 1174785877
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Entity Type | Individual
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Provider Name | CARLY GEMELLE CASAC-T
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 8 E 3RD ST
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City | NEW YORK
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State | NY
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Zip | 10003-8908
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Country | US
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Telephone | 212-763-0596
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Fax |
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Provider Business Mailing Address
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Address Line | 186 MESEROLE ST APT 6
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City | BROOKLYN
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State | NY
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Zip | 11206-2136
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Country | US
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Telephone | 917-686-9878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | TBA
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | TBA
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | TBA
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License Number State | NY
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