Provider Demographics
NPI:1902216617
Name:KANE, CARRIE STROUT (RD)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:STROUT
Last Name:KANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:STROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:620 MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-426-3600
Mailing Address - Fax:
Practice Address - Street 1:620 MADISON STREET
Practice Address - Street 2:HUTCHINGS PSYCHIATRIC CENTER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-426-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007889133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered