Provider Demographics
NPI:1861008682
Name:CARBONE, KATHRYN MARY
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARY
Last Name:CARBONE
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 1:131 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1227
Mailing Address - Country:US
Mailing Address - Phone:978-786-2441
Mailing Address - Fax:
Practice Address - Street 1:131 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-1227
Practice Address - Country:US
Practice Address - Phone:978-786-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker