Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1073475 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301006322 | MI |
Y | 1041C0700X | Clinical Social Worker | 6801020222 | MI |
NPI | 1073876603 |
---|---|
Provider Name | Mr. Gary Thomas Carone |
First Address | Newport, MI 48166-9152 |
Second Address | Detroit, MI 48228-3361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 14/07/2020 |