Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 023871 | NY |
N | 103T00000X | Psychologist | 023871 | NY |
Y | 103G00000X | Clinical Psychologist | 023871 | NY |
Y | 103TC0700X | Clinical Psychologist | 023871 | NY |
N | 103TH0100X | Health Service | 023871 | NY |
NPI | 1306394184 |
---|---|
Provider Name | Dr. Michael Carollo |
First Address | New York, NY 10032-3726 |
Second Address | New York, NY 10032-3726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2016 |
Last Update Date | 09/12/2021 |