Healthcare Provider Details

I. General information

NPI: 1568615185
Provider Name (Legal Business Name): MARY CARIOLA CHILDRENS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE SUITE 100
ROCH. NY
14620-3093
US

IV. Provider business mailing address

1000 ELMWOOD AVENUE SUITE 100
ROCHESTER NY
14620-3093
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-0761
  • Fax: 585-442-3143
Mailing address:
  • Phone: 585-271-0761
  • Fax: 585-442-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN ZANDI
Title or Position: PRESIDENT/CEO
Credential: LCSW
Phone: 585-271-0761