Provider Demographics
NPI:1639236367
Name:CARCELLI & CARCELLI PC
Entity Type:Organization
Organization Name:CARCELLI & CARCELLI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CARCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-317-1884
Mailing Address - Street 1:PO BOX 150307
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-479-8286
Mailing Address - Fax:801-479-8286
Practice Address - Street 1:4699 HARRISON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4368
Practice Address - Country:US
Practice Address - Phone:801-479-8286
Practice Address - Fax:801-479-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT61710350144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty