Provider Demographics
NPI:1891076576
Name:CARBARY, RENEE EILEEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:EILEEN
Last Name:CARBARY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1050
Mailing Address - Country:US
Mailing Address - Phone:585-394-5194
Mailing Address - Fax:
Practice Address - Street 1:96 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1453
Practice Address - Country:US
Practice Address - Phone:585-396-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY638141213Medicaid