Healthcare Provider Details

I. General information

NPI: 1528558905
Provider Name (Legal Business Name): MRS. CAROLYN DUNLAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

IV. Provider business mailing address

1 CIDER MILL LN
NATICK MA
01760-5898
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6319
  • Fax:
Mailing address:
  • Phone: 508-277-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1023339
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: