Provider Demographics
NPI:1952475360
Name:YEAGER, CAROLYN M (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:YEAGER
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 1:283 COMMACK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3400
Mailing Address - Country:US
Mailing Address - Phone:631-462-1032
Mailing Address - Fax:631-462-5620
Practice Address - Street 1:283 COMMACK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3400
Practice Address - Country:US
Practice Address - Phone:631-462-1032
Practice Address - Fax:631-462-5620
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical