Provider Demographics
NPI:1649413931
Name:CARCICH, KAREN JOHANNA (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JOHANNA
Last Name:CARCICH
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19708 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3515
Mailing Address - Country:US
Mailing Address - Phone:718-428-3279
Mailing Address - Fax:718-428-3279
Practice Address - Street 1:19708 46TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3515
Practice Address - Country:US
Practice Address - Phone:718-428-3279
Practice Address - Fax:718-428-3279
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006919-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker