Provider Demographics
NPI:1972037810
Name:CARBONE, RYAN (LICSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CARBONE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KINGSTON ST UNIT 710
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2253
Mailing Address - Country:US
Mailing Address - Phone:508-259-3170
Mailing Address - Fax:
Practice Address - Street 1:120 KINGSTON ST UNIT 710
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2253
Practice Address - Country:US
Practice Address - Phone:508-259-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2222521041C0700X
MA1226981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical