Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 079361 | NY |
NPI | 1003204561 |
---|---|
Provider Name | Typhani Carter |
First Address | Forest Hills, NY 11375-3629 |
Second Address | Forest Hills, NY 11375-7324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 06/01/2015 |