Provider Demographics
NPI:1629441407
Name:MIA L. CARBONE & ASSOCIATES, LLC. PSYCHOTHERAPY & WELLNESS PRACTICE
Entity Type:Organization
Organization Name:MIA L. CARBONE & ASSOCIATES, LLC. PSYCHOTHERAPY & WELLNESS PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:LISE
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, AY D
Authorized Official - Phone:978-235-2335
Mailing Address - Street 1:674 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1805
Mailing Address - Country:US
Mailing Address - Phone:978-235-2335
Mailing Address - Fax:
Practice Address - Street 1:674 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1805
Practice Address - Country:US
Practice Address - Phone:978-235-2335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty