Provider Demographics
NPI:1396848404
Name:CARELLI, GWEN E (LMHC)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:E
Last Name:CARELLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 NEW ESTATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1100
Mailing Address - Country:US
Mailing Address - Phone:978-501-6450
Mailing Address - Fax:508-752-7245
Practice Address - Street 1:202 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2265
Practice Address - Country:US
Practice Address - Phone:508-753-5554
Practice Address - Fax:508-752-7245
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health