Provider Demographics
NPI:1073876603
Name:CARONE, GARY THOMAS (MS LLP LMSW BCBA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:THOMAS
Last Name:CARONE
Suffix:
Gender:M
Credentials:MS LLP LMSW BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8165 SWAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9152
Mailing Address - Country:US
Mailing Address - Phone:734-673-6490
Mailing Address - Fax:
Practice Address - Street 1:19445 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3361
Practice Address - Country:US
Practice Address - Phone:313-307-0088
Practice Address - Fax:313-281-2235
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1073475103K00000X
MI6301006322103TB0200X
MI68010202221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral