Provider Demographics
NPI:1689774358
Name:HELMER, CAROL A (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HELMER
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 1:1 FREEMONT LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3234
Mailing Address - Country:US
Mailing Address - Phone:631-732-8820
Mailing Address - Fax:631-732-1030
Practice Address - Street 1:1 FREEMONT LN
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3234
Practice Address - Country:US
Practice Address - Phone:631-732-8820
Practice Address - Fax:631-732-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009523103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV41301Medicare ID - Type Unspecified