Provider Demographics
NPI:1891371308
Name:ASSENATO, CARLIE ANN
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:ANN
Last Name:ASSENATO
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 1:23 KERRY PARK
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2613
Mailing Address - Country:US
Mailing Address - Phone:585-441-2394
Mailing Address - Fax:
Practice Address - Street 1:23 KERRY PARK
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2613
Practice Address - Country:US
Practice Address - Phone:585-441-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11217101104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker