Provider Demographics
NPI:1679697619
Name:SYMER, CAROLE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:J
Last Name:SYMER
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 1:7 MUCHMORE LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-7401
Mailing Address - Country:US
Mailing Address - Phone:631-324-8515
Mailing Address - Fax:
Practice Address - Street 1:7 MUCHMORE LN
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-7401
Practice Address - Country:US
Practice Address - Phone:631-324-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014148-01103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVS0021Medicare PIN