Provider Demographics
NPI:1902405830
Name:CARBONE, TEJAH (LCSW)
Entity Type:Individual
Prefix:
First Name:TEJAH
Middle Name:
Last Name:CARBONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 S TANNER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-1202
Mailing Address - Country:US
Mailing Address - Phone:407-257-5015
Mailing Address - Fax:
Practice Address - Street 1:2630 S TANNER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32820-1202
Practice Address - Country:US
Practice Address - Phone:407-257-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW113231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical