Provider Demographics
NPI:1295920700
Name:THERESA CAREY
Entity type:Organization
Organization Name:THERESA CAREY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-817-7089
Mailing Address - Street 1:737 NORTH BROADWAY 2C
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NY
Mailing Address - Zip Code:10706
Mailing Address - Country:US
Mailing Address - Phone:914-231-6465
Mailing Address - Fax:
Practice Address - Street 1:737 N BROADWAY APT 2C
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-1026
Practice Address - Country:US
Practice Address - Phone:914-231-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0513841251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health