| Doctor Name: | CRAIG ADRIAN HEADLEY |
| NPI Number: | 1508263013 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | F401722 |
| Business Practice Address: | 5 Cornwall Ln Apt 2x Carle Place, NY - 115141083 |
| Business Phone Number: | 5162941728 |
| Business Fax Number: | |
| Mailing Address: | 5 Cornwall Ln Apt 2x, CARLE PLACE |
| State: | NY |
| Postal Code: | 115141083 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/26/2014 |
| NPI Last Update Date: | 11/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | F401722 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |