Provider Demographics
NPI:1922442052
Name:CARIS, JEFFREY (MA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CARIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3401
Mailing Address - Country:US
Mailing Address - Phone:607-737-5215
Mailing Address - Fax:607-737-5219
Practice Address - Street 1:150 LAKE ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3401
Practice Address - Country:US
Practice Address - Phone:607-737-5215
Practice Address - Fax:607-737-5219
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00642-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid