Healthcare Provider Details

I. General information

NPI: 1366442980
Provider Name (Legal Business Name): CAROL ANN MCCOIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SPEEN ST SUITE 105
FRAMINGHAM MA
01701-1898
US

IV. Provider business mailing address

70 EAGLE RD
WORCESTER MA
01605-3832
US

V. Phone/Fax

Practice location:
  • Phone: 508-620-1655
  • Fax: 508-620-0418
Mailing address:
  • Phone: 508-620-1655
  • Fax: 508-620-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1027981
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: