Provider Demographics
NPI:1063577252
Name:CARRETTA, ELIO (LICSW)
Entity type:Individual
Prefix:
First Name:ELIO
Middle Name:
Last Name:CARRETTA
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 1:210 WHITING PLACE
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3724
Mailing Address - Country:US
Mailing Address - Phone:781-740-2272
Mailing Address - Fax:339-200-8034
Practice Address - Street 1:210 WHITING PLACE
Practice Address - Street 2:SUITE # 5
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3724
Practice Address - Country:US
Practice Address - Phone:781-740-2272
Practice Address - Fax:339-200-8034
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20992Medicare ID - Type Unspecified