Healthcare Provider Details

I. General information

NPI: 1568531408
Provider Name (Legal Business Name): CAROLYN HOUSMAN MSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN WHYTE MSS

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 UNION STREET
NO MARSHFIELD MA
02059
US

IV. Provider business mailing address

PO BOX 86
NORTH MARSHFIELD MA
02059-0086
US

V. Phone/Fax

Practice location:
  • Phone: 781-837-1433
  • Fax:
Mailing address:
  • Phone: 781-837-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102537
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: