Provider Demographics
NPI:1902695505
Name:CARLO, WILLOUGHBY
Entity type:Individual
Prefix:
First Name:WILLOUGHBY
Middle Name:
Last Name:CARLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:WILLOUGHBY
Other - Middle Name:ANN GOLDEN
Other - Last Name:CARLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:51 FAIRVIEW STREET
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-254-6028
Mailing Address - Fax:802-254-7501
Practice Address - Street 1:51 FAIRVIEW STREET
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-254-6028
Practice Address - Fax:802-254-7501
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker