Provider Demographics
NPI:1356768055
Name:CARNEY, JESSICA (INTERN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CARNEY
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:INTERN
Mailing Address - Street 1:426 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2503
Mailing Address - Country:US
Mailing Address - Phone:516-850-4143
Mailing Address - Fax:
Practice Address - Street 1:55 HORIZON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4436
Practice Address - Country:US
Practice Address - Phone:631-920-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health