Healthcare Provider Details

I. General information

NPI: 1346617586
Provider Name (Legal Business Name): COLLEEN MARIE CARBONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

269 UNION ST
LYNN MA
01901-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-780-7459
  • Fax: 781-586-0280
Mailing address:
  • Phone: 781-780-7459
  • Fax: 781-586-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN2263263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: