Provider Demographics
NPI:1346250313
Name:KING, CARRIE ROCHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ROCHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 COURT ST
Mailing Address - Street 2:SUITE 904
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 COURT ST
Practice Address - Street 2:SUITE 904
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4404
Practice Address - Country:US
Practice Address - Phone:718-855-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015999174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist