Provider Demographics
NPI:1649620493
Name:EDICK, CARRIE I (NPP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:I
Last Name:EDICK
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 FRANKLIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2018
Mailing Address - Country:US
Mailing Address - Phone:518-788-7983
Mailing Address - Fax:866-256-3093
Practice Address - Street 1:430 FRANKLIN ST FL 2
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2018
Practice Address - Country:US
Practice Address - Phone:518-788-7983
Practice Address - Fax:866-256-3093
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402035363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04530181Medicaid