Provider Demographics
NPI:1609223379
Name:ST JOHN, CARLY ALEXANDRA (LMHC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ALEXANDRA
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-9731
Mailing Address - Country:US
Mailing Address - Phone:585-237-8170
Mailing Address - Fax:
Practice Address - Street 1:687 LEE RD STE 250
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4257
Practice Address - Country:US
Practice Address - Phone:585-237-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health