Provider Demographics
NPI:1548857717
Name:CARROCCIO, NICOLELYNN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLELYNN
Middle Name:MARIE
Last Name:CARROCCIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NICOLELYNN
Other - Middle Name:MARIE
Other - Last Name:CARROCCIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4914 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2374
Mailing Address - Country:US
Mailing Address - Phone:315-832-0093
Mailing Address - Fax:
Practice Address - Street 1:4914 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2374
Practice Address - Country:US
Practice Address - Phone:315-832-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111245-01104100000X
NY0997681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker