Healthcare Provider Details

I. General information

NPI: 1780167031
Provider Name (Legal Business Name): JULIA CARBONELLA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S BELLAIRE ST STE 907
DENVER CO
80222-4333
US

IV. Provider business mailing address

4860 ROBB ST STE 201
WHEAT RIDGE CO
80033-2162
US

V. Phone/Fax

Practice location:
  • Phone: 720-251-2770
  • Fax:
Mailing address:
  • Phone: 888-948-6789
  • Fax: 877-345-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5261
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: