Provider Demographics
NPI:1508995457
Name:MISKIV, CAROL A (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MISKIV
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 1:135 ALICIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4036
Mailing Address - Country:US
Mailing Address - Phone:631-669-3070
Mailing Address - Fax:631-669-5358
Practice Address - Street 1:135 ALICIA DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4036
Practice Address - Country:US
Practice Address - Phone:631-669-3070
Practice Address - Fax:631-669-5358
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV6A281Medicare ID - Type Unspecified