Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 020024-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 020024-1 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 020024 | NY |
NPI | 1093024283 |
---|---|
Provider Name | Dr. Kristin Joy Carothers |
First Address | New York, NY 10030 |
Second Address | New York, NY 10030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2010 |
Last Update Date | 01/10/2013 |