Provider Demographics
NPI:1568725497
Name:CARLONE, KERRY A (MS)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:A
Last Name:CARLONE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:ERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3070 SOUTHWESTERN BLVD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:716-675-0616
Mailing Address - Fax:716-675-7101
Practice Address - Street 1:3070 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1236
Practice Address - Country:US
Practice Address - Phone:716-675-0616
Practice Address - Fax:716-675-7101
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001362-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0561Medicare UPIN