MEDICARE: LUCILLE ANN CARNEVALE BT

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	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician		MA

General Provider Information

NPI Number	:	1952103707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCILLE ANN CARNEVALE BT

Provider Business Mailing Address
First Line	:	51 BIRMINGHAM CT
Second Line	:
City	:	MILFORD
State	:	MA
Zip	:	01757-1673
Country	:	US
Telephone Number	:	617-458-9927
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 BIRMINGHAM CT
Second Line	:
City	:	MILFORD
State	:	MA
Zip	:	01757-1673
Country	:	US
Telephone Number	:	617-458-9927
Fax Number	:

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

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	03/25/2025

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Directions to “ LUCILLE ANN CARNEVALE BT” Practice Location

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