| Doctor Name: | DR. NANCY JO CARBONELL |
| NPI Number: | 1346309606 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 6301007536 |
| Business Practice Address: | 9045 S. U.s. 31 University Medical Specialties Berrien Springs, MI - 49103 |
| Business Phone Number: | 2694732222 |
| Business Fax Number: | |
| Mailing Address: | 9045 S. U.s. 31, University Medical Specialties BERRIEN SPRINGS |
| State: | MI |
| Postal Code: | 49103 |
| Phone Number: | 2694732222 |
| Fax Number: | |
| NPI Enumeration Date: | 12/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 6301007536 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |