Basic Information
| Provider Information | |||||||||
| NPI: | 1942596010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARABALLO | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 372 WEST ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034312412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033380033 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 372 WEST ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034312412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033380033 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1598 | NH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.