Provider Demographics
NPI:1003873365
Name:CLINE, CARRIE DENISE III (MA CCCA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:DENISE
Last Name:CLINE
Suffix:III
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1542
Mailing Address - Country:US
Mailing Address - Phone:416-874-4500
Mailing Address - Fax:716-874-8145
Practice Address - Street 1:2128 ELMWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1910
Practice Address - Country:US
Practice Address - Phone:416-874-4500
Practice Address - Fax:716-874-8145
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0018381231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465154Medicaid
00026873201OtherUNIVERA COMMERCIAL
00026873201OtherPLUSMED
000576115007OtherCOMMUNITY BLUE
000576115007OtherCB ADVANTAGE
000576115007OtherCB LABOR HEALTH
000576115007OtherCOMMUNITY CARE
000576115007OtherBCBS WNY
00026873201OtherUNIVERA MEDICARE PPO
00026873201OtherCHILDHEALTH PLUS
000576115007OtherCHILD HEALTH PLUS FAMILY
00026873201OtherASO
000576115007OtherHMO 100
00026873201OtherUNIVERA HEALTHCARE TRADI
P00187911OtherRAILROAD MEDICARE
000576115007OtherHEALTHY NY
000576115007OtherSENIOR BLUE
000576115007OtherTRADITIONAL
000576115007OtherCHILD HEALTH PLUS FAMILY
00026873201OtherUNIVERA HEALTHCARE TRADI