Active NPI
Susanne Carmello, LMFT
- Marriage & Family Therapist
- Port Jefferson, NY
National Provider Identifier
1306516018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 001746-01
- Practice address
- 29 Laurel Dr
Port Jefferson, NY 11777-1903 - Phone
- (631) 681-9938
- NPI assigned
- Sep 14, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 001746-01 | NY | Primary |
Addresses
Primary practice location
29 Laurel Dr
Port Jefferson, NY 11777-1903
Mailing address
29 Laurel Dr
Port Jefferson, NY 11777-1903
Phone (631) 681-9938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001746-01 | NY | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631577600000",
"number": "1306516018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 LAUREL DR",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771903",
"telephone_number": "631-681-9938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 LAUREL DR",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771903",
"telephone_number": "631-681-9938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARMELLO",
"first_name": "SUSANNE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-14",
"last_updated": "2021-09-14",
"certification_date": "2021-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NY",
"license": "001746-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.