Healthcare Provider Details

I. General information

NPI: 1194911297
Provider Name (Legal Business Name): LIANNE R CARBONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TEATICKET HWY UNIT 4
TEATICKET MA
02536-5637
US

IV. Provider business mailing address

16 ALMA RD
FALMOUTH MA
02540-3602
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-4532
  • Fax: 508-495-3258
Mailing address:
  • Phone: 508-540-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: