Provider Demographics
NPI:1134307770
Name:CARBONELL, MELINDA S (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:S
Last Name:CARBONELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4017
Mailing Address - Country:US
Mailing Address - Phone:516-396-0064
Mailing Address - Fax:
Practice Address - Street 1:44 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4017
Practice Address - Country:US
Practice Address - Phone:516-396-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062534104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY062534OtherLICENSE NUMBER