Healthcare Provider Details

I. General information

NPI: 1457783565
Provider Name (Legal Business Name): CARON A BIXBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 BABCOCK ST
BROOKLINE MA
02446-6773
US

IV. Provider business mailing address

227 BABCOCK ST
BROOKLINE MA
02446-6773
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-9200
  • Fax:
Mailing address:
  • Phone: 978-609-2235
  • Fax: 617-566-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN275795
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: