MEDICARE: KAITLIN CARSON

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
1	103TC0700X	Clinical Psychologist	027505	NY

General Provider Information

NPI Number	:	1194469569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN CARSON

Provider Business Mailing Address
First Line	:	400 KING ST STE 7
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 KING ST STE 7
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3500
Country	:	US
Telephone Number	:	347-560-4628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	12/04/2025

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Directions to “ KAITLIN CARSON ” Practice Location

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