Provider Demographics
NPI:1851989149
Name:CARABALLO, GISELLE M
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:M
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CHARPENTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-2135
Mailing Address - Country:US
Mailing Address - Phone:413-313-8629
Mailing Address - Fax:
Practice Address - Street 1:37 CHARPENTIER BLVD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2135
Practice Address - Country:US
Practice Address - Phone:413-313-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician