Healthcare Provider Details

I. General information

NPI: 1013907658
Provider Name (Legal Business Name): CAROL G TAYLOR EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE SALEM GREEN SUITE 555
SALEM MA
01970
US

IV. Provider business mailing address

ONE SALEM GREEN SUITE 555
SALEM MA
01970
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-8442
  • Fax: 978-887-7383
Mailing address:
  • Phone: 978-744-8442
  • Fax: 978-887-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4017
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: