Healthcare Provider Details

I. General information

NPI: 1205823218
Provider Name (Legal Business Name): CAROLYN M BELL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST SUITE 315
SPRINGFIELD MA
01104-2301
US

IV. Provider business mailing address

299 CAREW ST SUITE 315
SPRINGFIELD MA
01104-2301
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-2060
  • Fax:
Mailing address:
  • Phone: 413-732-2060
  • Fax: 413-589-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1016252
License Number StateMA

VII. Legacy identifiers

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

# 1
IdentifierP04906
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS/BS
# 2
Identifier1892975
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: