Healthcare Provider Details

I. General information

NPI: 1043795933
Provider Name (Legal Business Name): CAROLYN L CUNEO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 SYCAMORE ST
LOWELL MA
01852-3718
US

IV. Provider business mailing address

11 ONTARIO DR
HUDSON MA
01749-3122
US

V. Phone/Fax

Practice location:
  • Phone: 978-970-5470
  • Fax: 978-970-5466
Mailing address:
  • Phone: 978-562-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number111707
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: