Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0114721 | NY |
NPI | 1003911173 |
---|---|
Provider Name | Dr. Suellen M Carney |
First Address | New York, NY 10021-6451 |
Second Address | New York, NY 10021-6451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |