Provider Demographics
NPI:1790921799
Name:CARVER WILE PSYCHOLOGY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:CARVER WILE PSYCHOLOGY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-593-7825
Mailing Address - Street 1:200 ATLANTIC AVE
Mailing Address - Street 2:1SR FLOOR OFFICES
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3505
Mailing Address - Country:US
Mailing Address - Phone:516-593-7828
Mailing Address - Fax:516-887-2566
Practice Address - Street 1:200 ATLANTIC AVE
Practice Address - Street 2:1SR FLOOR OFFICES
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3505
Practice Address - Country:US
Practice Address - Phone:516-593-7828
Practice Address - Fax:516-887-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-21
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV84141Medicare PIN