Healthcare Provider Details

I. General information

NPI: 1548313687
Provider Name (Legal Business Name): JOHN LAWRENCE CAREW PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAGAMORE TRL
LITTLETON MA
01460-1306
US

IV. Provider business mailing address

15 SAGAMORE TRL
LITTLETON MA
01460-1306
US

V. Phone/Fax

Practice location:
  • Phone: 978-486-8105
  • Fax: 978-486-1044
Mailing address:
  • Phone: 978-486-8105
  • Fax: 978-486-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3609
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: