Provider Demographics
NPI:1063586865
Name:CARBONE, MARTHA C (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:C
Last Name:CARBONE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE ON DELAWARE
Mailing Address - State:PA
Mailing Address - Zip Code:18356-0158
Mailing Address - Country:US
Mailing Address - Phone:570-476-9514
Mailing Address - Fax:
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-476-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist