Healthcare Provider Details

I. General information

NPI: 1942677034
Provider Name (Legal Business Name): CAROLYN NORTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN KELLEY LCSW

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 GLADES RD SUITE 225
BOCA RATON FL
33434-4176
US

IV. Provider business mailing address

1515 W PALMETTO PARK RD SUITE 225
BOCA RATON FL
33486-3307
US

V. Phone/Fax

Practice location:
  • Phone: 561-361-0500
  • Fax: 561-479-0384
Mailing address:
  • Phone: 561-395-8920
  • Fax: 561-338-9127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: