Healthcare Provider Details

I. General information

NPI: 1699825265
Provider Name (Legal Business Name): JULIE CARBONI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 21
BEN LOMOND CA
95005-0021
US

IV. Provider business mailing address

PO BOX 21
BEN LOMOND CA
95005-0021
US

V. Phone/Fax

Practice location:
  • Phone: 408-568-6476
  • Fax:
Mailing address:
  • Phone: 408-568-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: