Provider Demographics
NPI:1275324899
Name:CARBONELLI CONSULTATION
Entity type:Organization
Organization Name:CARBONELLI CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:224-523-4236
Mailing Address - Street 1:3703 E ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1108
Mailing Address - Country:US
Mailing Address - Phone:224-523-4236
Mailing Address - Fax:
Practice Address - Street 1:3383 E LAYTON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1437
Practice Address - Country:US
Practice Address - Phone:224-523-4236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health