Basic Information
| Provider Information | |||||||||
| NPI: | 1538256540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859227267 | ||||||||
| FaxNumber: | 5859227246 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859227267 | ||||||||
| FaxNumber: | 5859227246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 01/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R043675-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P010043675 | 01 | NY | EXCELLUS IDENTIFIER NUMBE | OTHER |