Provider Demographics
NPI:1265841795
Name:CARBONE, CLARE JULIAN STEPHANIE (LCSW)
Entity type:Individual
Prefix:
First Name:CLARE JULIAN
Middle Name:STEPHANIE
Last Name:CARBONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CLARE JULAN
Other - Middle Name:STEPHANIE
Other - Last Name:CARBONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4465 S 900 E STE 150
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3944
Mailing Address - Country:US
Mailing Address - Phone:435-248-2089
Mailing Address - Fax:801-207-5104
Practice Address - Street 1:4465 S 900 E STE 150
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3944
Practice Address - Country:US
Practice Address - Phone:435-248-2089
Practice Address - Fax:801-207-5104
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
UT13922735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265841795OtherBLUE CROSS BLUE SHIELD