Provider Demographics
NPI:1447277959
Name:CARBONE, VICTOR JOSEPH (ED D)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:JOSEPH
Last Name:CARBONE
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 PARKER ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1042
Mailing Address - Country:US
Mailing Address - Phone:413-782-7777
Mailing Address - Fax:413-426-9600
Practice Address - Street 1:1188 PARKER ST
Practice Address - Street 2:STE 1
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1042
Practice Address - Country:US
Practice Address - Phone:413-782-7777
Practice Address - Fax:413-426-9600
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0520667Medicaid
107826OtherAMISYT HMO BLUE
MACAW04795OtherBLUE CROSS
MA0520667Medicaid