Healthcare Provider Details

I. General information

NPI: 1821915372
Provider Name (Legal Business Name): CAROLYN DELEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 MAIN ST STE 301
MALDEN MA
02148-5017
US

IV. Provider business mailing address

12 TEMPLE PL APT 3
LYNN MA
01905-3307
US

V. Phone/Fax

Practice location:
  • Phone: 617-804-2773
  • Fax:
Mailing address:
  • Phone: 781-732-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: