Provider Demographics
NPI:1447513627
Name:JEROME, CARRIE S (MS SP ED)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:S
Last Name:JEROME
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3518
Mailing Address - Country:US
Mailing Address - Phone:516-489-7279
Mailing Address - Fax:
Practice Address - Street 1:686 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3518
Practice Address - Country:US
Practice Address - Phone:516-489-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist