Provider Demographics
NPI:1134451974
Name:GOUBOTH, CARINE F (LPN)
Entity type:Individual
Prefix:MRS
First Name:CARINE
Middle Name:F
Last Name:GOUBOTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROCKLAND LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3141
Mailing Address - Country:US
Mailing Address - Phone:845-290-0079
Mailing Address - Fax:
Practice Address - Street 1:140 ROCKLAND LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3141
Practice Address - Country:US
Practice Address - Phone:845-290-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2852791164W00000X
NY808047163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No164W00000XNursing Service ProvidersLicensed Practical Nurse