Provider Demographics
NPI:1083344121
Name:PRIETO, CARLOS (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:PRIETO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLAZA ST E STE 1D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4939
Mailing Address - Country:US
Mailing Address - Phone:718-636-1916
Mailing Address - Fax:
Practice Address - Street 1:10 PLAZA ST E STE 1D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4939
Practice Address - Country:US
Practice Address - Phone:718-636-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13805-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist