Provider Demographics
NPI:1588639140
Name:CAREY-DICARLO, AMY B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:B
Last Name:CAREY-DICARLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1871
Mailing Address - Country:US
Mailing Address - Phone:781-985-3914
Mailing Address - Fax:
Practice Address - Street 1:469 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1871
Practice Address - Country:US
Practice Address - Phone:781-985-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115542104100000X, 1041C0700X
MELC114121041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
483127OtherVALUE OPTIONS
ME432940200OtherMAINECARE/MEDICAID
MAP08110OtherBCBS
ME432940200OtherMAINECARE/MEDICAID