Healthcare Provider Details

I. General information

NPI: 1104789593
Provider Name (Legal Business Name): CARRIE A MAILHOIT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DUNHAM RIDGE RD SUITE 3200-3350
BEVERLY MA
01915
US

IV. Provider business mailing address

20 POND ST
BEVERLY MA
01915-4322
US

V. Phone/Fax

Practice location:
  • Phone: 978-600-0816
  • Fax:
Mailing address:
  • Phone: 978-491-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW3032623
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: