Provider Demographics
NPI:1902958333
Name:STERN, CAROLE GENE (MS, RNC)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:GENE
Last Name:STERN
Suffix:
Gender:F
Credentials:MS, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S ARCH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3515
Mailing Address - Country:US
Mailing Address - Phone:724-626-9941
Mailing Address - Fax:724-626-2785
Practice Address - Street 1:110 S ARCH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3515
Practice Address - Country:US
Practice Address - Phone:724-626-9941
Practice Address - Fax:724-626-2785
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007986L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015260180003Medicaid