Healthcare Provider Details

I. General information

NPI: 1558328716
Provider Name (Legal Business Name): CARMEL REID HEINSOHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH ST
BROOKLINE MA
02467-3658
US

IV. Provider business mailing address

28 BEAVERBROOK RD
NORFOLK MA
02056-1522
US

V. Phone/Fax

Practice location:
  • Phone: 617-676-3315
  • Fax: 617-469-5013
Mailing address:
  • Phone: 508-816-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number59125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: