Provider Demographics
NPI:1700816741
Name:USCHOLD-KLEPFER, CARISSA CATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:CATHERINE
Last Name:USCHOLD-KLEPFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1764
Mailing Address - Country:US
Mailing Address - Phone:716-885-1392
Mailing Address - Fax:
Practice Address - Street 1:70 BARKER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2013
Practice Address - Country:US
Practice Address - Phone:716-883-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0711121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00688211Medicaid
NY072071Medicare ID - Type Unspecified
NYP85761Medicare UPIN