Provider Demographics
NPI:1265837728
Name:DENTINO, CARRIE RENEE
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:RENEE
Last Name:DENTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3818
Mailing Address - Country:US
Mailing Address - Phone:315-271-5382
Mailing Address - Fax:
Practice Address - Street 1:107 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3818
Practice Address - Country:US
Practice Address - Phone:315-271-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001604-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health