Basic Information
Provider Information
NPI: 1972771681
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARPENTER-SARMIENTO
FirstName: HEATHER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 155 CRYSTAL RUN RD
Address2:  
City: MIDDLETOWN
State: NY
PostalCode: 109414028
CountryCode: US
TelephoneNumber: 8457036999
FaxNumber: 8457036297
Practice Location
Address1: 155 CRYSTAL RUN RD
Address2:  
City: MIDDLETOWN
State: NY
PostalCode: 109414028
CountryCode: US
TelephoneNumber: 8457036999
FaxNumber: 8457036297
Other Information
ProviderEnumerationDate: 02/15/2008
LastUpdateDate: 08/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X017552NYY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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