Provider Demographics
NPI:1033498530
Name:CARNEIRO, MARLENE (RD)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:CARNEIRO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:
Other - Last Name:VRANICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:113 WHITLOCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1114
Mailing Address - Country:US
Mailing Address - Phone:914-497-1172
Mailing Address - Fax:
Practice Address - Street 1:113 WHITLOCKVILLE RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536
Practice Address - Country:US
Practice Address - Phone:914-497-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-56295174N00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered