Basic Information
| Provider Information | |||||||||
| NPI: | 1396848404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARELLI | ||||||||
| FirstName: | GWEN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 NEW ESTATE RD | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014601100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785016450 | ||||||||
| FaxNumber: | 5087527245 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016092265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087535554 | ||||||||
| FaxNumber: | 5087527245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 01/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4731 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.