Provider Demographics
NPI:1902395676
Name:DEAN, CARRIE HEATH (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:HEATH
Last Name:DEAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3552
Mailing Address - Country:US
Mailing Address - Phone:917-294-9277
Mailing Address - Fax:
Practice Address - Street 1:38 OAK AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3552
Practice Address - Country:US
Practice Address - Phone:917-294-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-132185174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN