Provider Demographics
NPI:1275236283
Name:CARBENIA, EMILY N
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:N
Last Name:CARBENIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2684 EDELWEISS ST NE APT 4
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2679
Mailing Address - Country:US
Mailing Address - Phone:330-594-8608
Mailing Address - Fax:
Practice Address - Street 1:2684 EDELWEISS ST NE APT 4
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2679
Practice Address - Country:US
Practice Address - Phone:330-594-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty