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General NPI Number Information
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NPI Number | 1114938479
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Entity Type | Individual
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Provider Name | CAROLYN DANA MARVEL LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 800 CUMMINGS CTR SUITE 266T
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City | BEVERLY
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State | MA
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Zip | 01915-6175
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Country | US
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Telephone | 978-921-1190
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Fax | 978-927-3724
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Provider Business Mailing Address
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Address Line | 23 ROWELL AVE
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City | BEVERLY
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State | MA
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Zip | 01915
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Country | US
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Telephone | 978-712-9781
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Fax | 978-927-3724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 110634
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License Number State | MA
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