Provider Demographics
NPI:1255330841
Name:BAMBERGER-CARROLL, JUDITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:BAMBERGER-CARROLL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1633
Mailing Address - Country:US
Mailing Address - Phone:516-569-6828
Mailing Address - Fax:516-569-6828
Practice Address - Street 1:1025 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1633
Practice Address - Country:US
Practice Address - Phone:516-569-6828
Practice Address - Fax:516-569-6828
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015245103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist