Doctor Name: | CAROLYN VELLA |
NPI Number: | 1124411475 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CASAC |
License Number: | 25032 |
Business Practice Address: | 475 E Main St Patchogue, NY - 117723121 |
Business Phone Number: | 6315697266 |
Business Fax Number: | |
Mailing Address: | 98 Pine St, PATCHOGUE |
State: | NY |
Postal Code: | 117721019 |
Phone Number: | 6317582538 |
Fax Number: | |
NPI Enumeration Date: | 03/11/2015 |
NPI Last Update Date: | 03/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 25032 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |