Provider Demographics
NPI:1073214888
Name:DENNIS, CAROLINE (LMSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CONOVER XING
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8980
Mailing Address - Country:US
Mailing Address - Phone:607-227-8830
Mailing Address - Fax:
Practice Address - Street 1:2510 CHILI AVE STE 5
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3334
Practice Address - Country:US
Practice Address - Phone:607-227-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118837104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker