Healthcare Provider Details

I. General information

NPI: 1083546394
Provider Name (Legal Business Name): KATHLEEN MARIE CARVALHO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34A HARVARD RD
SHIRLEY MA
01464-2471
US

IV. Provider business mailing address

34A HARVARD RD
SHIRLEY MA
01464-2471
US

V. Phone/Fax

Practice location:
  • Phone: 857-285-0420
  • Fax:
Mailing address:
  • Phone: 857-285-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN1003249
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: