Provider Demographics
NPI:1710205562
Name:CARON, STACI
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:CARON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:KOVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10787
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-0787
Mailing Address - Country:US
Mailing Address - Phone:585-922-1124
Mailing Address - Fax:585-922-1020
Practice Address - Street 1:625 SCIO STREET
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2660
Practice Address - Country:US
Practice Address - Phone:585-262-8850
Practice Address - Fax:585-922-1020
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0718431041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool