1720147713 NPI number — MRS. HOPE ELLEN CARBONARO MSW LCSW

Table of content: MRS. HOPE ELLEN CARBONARO MSW LCSW (NPI 1720147713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720147713 NPI number — MRS. HOPE ELLEN CARBONARO MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARBONARO
Provider First Name:
HOPE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RHODES
Provider Other First Name:
HOPE
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720147713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 DODDS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT VERNON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-246-0246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DOCTORS PARK ROAD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
MT VERNON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-944-0344
Provider Business Practice Location Address Fax Number:
618-244-1455
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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