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NPI Code Detail

MEDICARE: RICHARD E CARR PSYD

MEDICARE: RICHARD E CARR PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist35SI00312100NJ
2103TC0700XClinical Psychologist010456-1NY

General Provider Information

NPI Number : 1104904499
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD E CARR PSYD
Provider Business Mailing Address
First Line : 3512 QUENTIN RD STE 110
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4245
Country : US
Telephone Number : 718-942-6595
Fax Number :
Provider Business Practice Location Address
First Line : 3512 QUENTIN RD STE 110
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4245
Country : US
Telephone Number : 718-942-6595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 08/27/2019

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