Provider Demographics
NPI:1154027415
Name:MANTELLO, CARLIE
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:MANTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 AMERICAN LEGION DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-3942
Mailing Address - Country:US
Mailing Address - Phone:413-822-5469
Mailing Address - Fax:
Practice Address - Street 1:124 AMERICAN LEGION DR
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-3942
Practice Address - Country:US
Practice Address - Phone:413-822-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other