MEDICARE: DR. JAMES CARNELIA PH.D.

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	009994	NY

General Provider Information

NPI Number	:	1508987405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES CARNELIA PH.D.

Provider Business Mailing Address
First Line	:	38 E 81ST ST
Second Line	:	SUITE #5-B
City	:	NEW YORK
State	:	NY
Zip	:	10028-0216
Country	:	US
Telephone Number	:	212-472-5974
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 E 11TH ST FL 4
Second Line	:	C-O WASHINGTON SQUARE INSTITUTE
City	:	NEW YORK
State	:	NY
Zip	:	10003-4602
Country	:	US
Telephone Number	:	212-472-5974
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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