Provider Demographics
NPI:1699795369
Name:CARBONE, LISA JANE (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:CARBONE
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 1:8 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950-4501
Mailing Address - Country:US
Mailing Address - Phone:207-696-3992
Mailing Address - Fax:207-696-3974
Practice Address - Street 1:8 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950
Practice Address - Country:US
Practice Address - Phone:207-696-3992
Practice Address - Fax:207-696-3974
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC54941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431824699Medicaid
ME1699795369Medicaid
ME431824699Medicaid
MEME2335Medicare PIN
MEMD233503Medicare PIN