Provider Demographics
NPI:1326361858
Name:BONGIORNO, CAROL ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 RAILROAD AVE
Mailing Address - Street 2:SUITE 5 AND 7
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1858
Mailing Address - Country:US
Mailing Address - Phone:781-780-3037
Mailing Address - Fax:978-750-0370
Practice Address - Street 1:23 RAILROAD AVE
Practice Address - Street 2:SUITES 5 AND 7
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1858
Practice Address - Country:US
Practice Address - Phone:781-780-3037
Practice Address - Fax:978-750-0370
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health