Provider Demographics
NPI:1013577840
Name:CARBONE, LORETTA ANN (MSW)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ANN
Last Name:CARBONE
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 1:3131 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1658
Mailing Address - Country:US
Mailing Address - Phone:248-483-0326
Mailing Address - Fax:
Practice Address - Street 1:3131 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1658
Practice Address - Country:US
Practice Address - Phone:248-483-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6801072378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker