Individual
DR. MICHAEL CAROLLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
710 W 168TH ST FL 12, NEW YORK, NY 10032-3726
(212) 305-9758
Mailing address
710 W 168TH ST FL 12, NEW YORK, NY 10032-3726
(212) 729-0354
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
023871
NY
103TC0700X
Clinical Psychologist
Primary
023871
NY
103TH0100X
Health Service Psychologist
023871
NY
Other
Enumeration date
09/21/2016
Last updated
12/09/2021
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