Provider Demographics
NPI:1629346184
Name:CAFORIO-NUNCIATO, KIM PAULETTE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:PAULETTE
Last Name:CAFORIO-NUNCIATO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 MACBEAN LN
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-9387
Mailing Address - Country:US
Mailing Address - Phone:607-753-0994
Mailing Address - Fax:
Practice Address - Street 1:20 ENFIELD MAIN RD
Practice Address - Street 2:ENFIELD ELEMENTARY SCHOOL
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9367
Practice Address - Country:US
Practice Address - Phone:607-274-2221
Practice Address - Fax:607-274-6810
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041058-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041058-1OtherSOCAIL WORK LICENSE NUMBER