Provider Demographics
NPI:1194911297
Name:CARBONE, LIANNE R
Entity type:Individual
Prefix:
First Name:LIANNE
Middle Name:R
Last Name:CARBONE
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 1:16 ALMA RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3602
Mailing Address - Country:US
Mailing Address - Phone:508-540-1837
Mailing Address - Fax:
Practice Address - Street 1:180 TEATICKET HWY UNIT 4
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5637
Practice Address - Country:US
Practice Address - Phone:508-540-4532
Practice Address - Fax:508-495-3258
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1530861Medicaid