Provider Demographics
NPI:1609156629
Name:MERANTE, CAROLYN ANNE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANNE
Last Name:MERANTE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:ANNE
Other - Last Name:BAZAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:106 FLINT PATH
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3404
Mailing Address - Country:US
Mailing Address - Phone:315-657-4428
Mailing Address - Fax:
Practice Address - Street 1:1744 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204
Practice Address - Country:US
Practice Address - Phone:315-468-3414
Practice Address - Fax:315-468-2089
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013497-BEING REACTIV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist