Provider Demographics
NPI:1811088743
Name:CARBONELL, EVELYN (LCSW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:CARBONELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 PALERMO DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8033
Mailing Address - Country:US
Mailing Address - Phone:941-815-0266
Mailing Address - Fax:941-639-6831
Practice Address - Street 1:1700 EDUCATION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-6222
Practice Address - Country:US
Practice Address - Phone:941-639-8300
Practice Address - Fax:941-639-6831
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional