Healthcare Provider Details

I. General information

NPI: 1932575941
Provider Name (Legal Business Name): CARSON AM TABIOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDDAC-BAVARIA PSC 411 UNIT 28037
APO AE
09112
US

IV. Provider business mailing address

MEDDAC-BAVARIA PSC 411 UNIT 28037
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC849
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2059
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: