Provider Demographics
NPI:1720147713
Name:CARBONARO, HOPE ELLEN (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HOPE
Middle Name:ELLEN
Last Name:CARBONARO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MISS
Other - First Name:HOPE
Other - Middle Name:ELLEN
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1520 DODDS
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864
Mailing Address - Country:US
Mailing Address - Phone:618-246-0246
Mailing Address - Fax:
Practice Address - Street 1:1 DOCTORS PARK ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:MT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864
Practice Address - Country:US
Practice Address - Phone:618-944-0344
Practice Address - Fax:618-244-1455
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker