Provider Demographics
NPI:1568615185
Name:MARY CARIOLA CHILDRENS CENTER
Entity Type:Organization
Organization Name:MARY CARIOLA CHILDRENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANDI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-271-0761
Mailing Address - Street 1:1000 ELMWOOD AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3093
Mailing Address - Country:US
Mailing Address - Phone:585-271-0761
Mailing Address - Fax:585-442-3143
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCH.
Practice Address - State:NY
Practice Address - Zip Code:14620-3093
Practice Address - Country:US
Practice Address - Phone:585-271-0761
Practice Address - Fax:585-442-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
251B00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1265504385Medicaid
NY1306918420Medicaid
NY1770655805Medicaid
NY1093887101Medicaid