Provider Demographics
NPI:1912776477
Name:ZANDI, CARMALETTA KAYE (LSW)
Entity Type:Individual
Prefix:
First Name:CARMALETTA
Middle Name:KAYE
Last Name:ZANDI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4424
Mailing Address - Country:US
Mailing Address - Phone:716-842-1300
Mailing Address - Fax:716-249-3388
Practice Address - Street 1:140 GENESEE ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4424
Practice Address - Country:US
Practice Address - Phone:716-842-1300
Practice Address - Fax:716-249-3388
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.110852101YM0800X, 104100000X
NY101YP1600X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator