Healthcare Provider Details

I. General information

NPI: 1194688630
Provider Name (Legal Business Name): CARLINE PAUL PMHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST FL 14
BOSTON MA
02114-2509
US

IV. Provider business mailing address

100 CAMBRIDGE ST FL 14
BOSTON MA
02114-2509
US

V. Phone/Fax

Practice location:
  • Phone: 508-462-9943
  • Fax:
Mailing address:
  • Phone: 603-286-0024
  • Fax: 603-286-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2389110
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: