MEDICARE: MS. CARMELINA PERALTA PHD

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	011594	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912057597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARMELINA PERALTA PHD

Provider Business Mailing Address
First Line	:	4 HUNTINGTON RD
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-1703
Country	:	US
Telephone Number	:	631-271-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 HUNTINGTON RD
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-1703
Country	:	US
Telephone Number	:	631-271-3319
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	11/16/2020

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