Provider Demographics
NPI:1871756965
Name:HANEY, CAROLYN DIANE (MSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:DIANE
Last Name:HANEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 STEELE ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4725
Mailing Address - Country:US
Mailing Address - Phone:307-745-3706
Mailing Address - Fax:307-742-6702
Practice Address - Street 1:1050 N 3RD ST
Practice Address - Street 2:SUITE B1
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2544
Practice Address - Country:US
Practice Address - Phone:307-742-4769
Practice Address - Fax:307-742-6702
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-4261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical