Individual
STACEY MOUSAW CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203-1899
(315) 726-8600
Mailing address
5465 ORANGEPORT RD UNIT 503, BREWERTON, NY 13029-1804
(252) 675-8887
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404991
NY
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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