Provider Demographics
NPI:1093990269
Name:CARELLA, MARIA J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:J
Last Name:CARELLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 STATE RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-3525
Mailing Address - Country:US
Mailing Address - Phone:508-674-7780
Mailing Address - Fax:
Practice Address - Street 1:35 STATE RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-3525
Practice Address - Country:US
Practice Address - Phone:508-674-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical