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General NPI Number Information
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NPI Number | 1275324899
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Entity Type | Organization
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Legal Business Name | CARBONELLI CONSULTATION
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 3383 E LAYTON AVE
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City | CUDAHY
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State | WI
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Zip | 53110-1437
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Country | US
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Telephone | 224-523-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 3703 E ALLERTON AVE
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City | CUDAHY
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State | WI
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Zip | 53110-1108
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Country | US
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Telephone | 224-523-4236
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MATTHEW CARBONELLI
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Credential | PHD
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Telephone | 224-523-4236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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