Healthcare Provider Details

I. General information

NPI: 1164009965
Provider Name (Legal Business Name): CAROLYN JEAN PIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 VARNOIS
BRIMFIELD MA
01010
US

IV. Provider business mailing address

80 BRUSH HILL AVE APT 29
WEST SPRINGFIELD MA
01089-1222
US

V. Phone/Fax

Practice location:
  • Phone: 413-896-5434
  • Fax:
Mailing address:
  • Phone: 413-234-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: