Provider Demographics
NPI:1922400993
Name:BARTOLUCCI, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BARTOLUCCI
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 1:459 RIVERDALE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4605
Mailing Address - Country:US
Mailing Address - Phone:413-733-3196
Mailing Address - Fax:413-736-1037
Practice Address - Street 1:459 RIVERDALE ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4605
Practice Address - Country:US
Practice Address - Phone:413-733-3196
Practice Address - Fax:413-736-1037
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81237700000X
CT000434237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist