Provider Demographics
NPI:1851541437
Name:FISCHETTI, CARRIE L (MS ED)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:FISCHETTI
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 MCFADDEN DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2721
Mailing Address - Country:US
Mailing Address - Phone:631-757-1997
Mailing Address - Fax:
Practice Address - Street 1:1213 MCFADDEN DR
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2721
Practice Address - Country:US
Practice Address - Phone:631-757-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1924320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist