Provider Demographics
NPI:1780201723
Name:GIAMBRONE, CARLA A
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:GIAMBRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3513
Mailing Address - Country:US
Mailing Address - Phone:585-202-6001
Mailing Address - Fax:
Practice Address - Street 1:129 W COMMERCIAL ST STE 5
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2171
Practice Address - Country:US
Practice Address - Phone:585-202-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023725-01103TH0004X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent