Provider Demographics
NPI:1912079302
Name:CARLSEN, ANDREA R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:R
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:75 PROSPECT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3320
Mailing Address - Country:US
Mailing Address - Phone:631-923-0006
Mailing Address - Fax:844-314-9910
Practice Address - Street 1:75 PROSPECT ST STE 102
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3320
Practice Address - Country:US
Practice Address - Phone:631-923-0006
Practice Address - Fax:844-314-9910
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2426342084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry