Provider Demographics
NPI:1912063561
Name:EMETERIO, CHARLENE ELIZABETH (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:ELIZABETH
Last Name:EMETERIO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E CHESTNUT ST STE 14
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3660
Mailing Address - Country:US
Mailing Address - Phone:315-335-4592
Mailing Address - Fax:315-336-4800
Practice Address - Street 1:608 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5422
Practice Address - Country:US
Practice Address - Phone:315-335-4592
Practice Address - Fax:315-336-4800
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0532891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02514405Medicaid
NYQ04942Medicare UPIN
NY02514405Medicaid