Individual
CARRIE IMPERATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
53345 MAIN RD, SOUTHOLD, NY 11971-4643
(631) 765-2100
Mailing address
PO BOX 523, SOUTHOLD, NY 11971-0523
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
022202
NY
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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