MEDICARE: LISA JANE CARBONE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC5494	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699795369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JANE CARBONE LCSW

Provider Business Mailing Address
First Line	:	8 S MAIN ST
Second Line	:
City	:	MADISON
State	:	ME
Zip	:	04950-4501
Country	:	US
Telephone Number	:	207-696-3992
Fax Number	:	207-696-3974

Provider Business Practice Location Address
First Line	:	8 SOUTH MAIN ST
Second Line	:
City	:	MADISON
State	:	ME
Zip	:	04950
Country	:	US
Telephone Number	:	207-696-3992
Fax Number	:	207-696-3974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	03/07/2014

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Directions to “ LISA JANE CARBONE LCSW” Practice Location

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