Individual
CARLENE J IANUZZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
300 MAIN ST, SUITE 5, VESTAL, NY 13850-1545
(607) 323-4110
(607) 323-4109
Mailing address
300 MAIN ST, SUITE 5, VESTAL, NY 13850-1545
(607) 323-4110
(607) 323-4109
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
013995
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02046142
—
NY
Enumeration date
11/21/2006
Last updated
12/14/2012
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