Healthcare Provider Details

I. General information

NPI: 1922174051
Provider Name (Legal Business Name): GAETANA CIARLANTE LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GOLDEN HILL LN
KINGSTON NY
12401-6441
US

IV. Provider business mailing address

PO BOX 592 7 YORK ST.
GLASCO NY
12432-0592
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-4000
  • Fax: 845-340-4094
Mailing address:
  • Phone: 845-246-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR031507-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: