Healthcare Provider Details

I. General information

NPI: 1699059956
Provider Name (Legal Business Name): CARROLL SUZANNE MCGRATH RNPC, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 RUSSELL ST SUITE 203
HADLEY MA
01035-3534
US

IV. Provider business mailing address

234 RUSSELL ST SUITE 203
HADLEY MA
01035-3534
US

V. Phone/Fax

Practice location:
  • Phone: 413-367-6337
  • Fax: 413-320-4797
Mailing address:
  • Phone: 413-367-6337
  • Fax: 413-320-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN265957
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: