Provider Demographics
NPI:1083876817
Name:CARBONELL-LONG, LILIAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LILIAN
Middle Name:
Last Name:CARBONELL-LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 LIVE OAK RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8555
Mailing Address - Country:US
Mailing Address - Phone:303-955-8832
Mailing Address - Fax:
Practice Address - Street 1:1546 LIVE OAK RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-8555
Practice Address - Country:US
Practice Address - Phone:720-201-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO711041C0700X
TX260291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical