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General NPI Number Information
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NPI Number | 1124110929
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Entity Type | Individual
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Provider Name | CAROL BAXTER M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 2228 BLACK ROCK TURNPIKE SUITE 311
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City | FAIRFIELD
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State | CT
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Zip | 06825
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Country | US
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Telephone | 203-366-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 416 PEQUOT AVENUE
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City | SOUTHPORT
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State | CT
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Zip | 06890
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Country | US
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Telephone | 203-209-4136
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Fax |
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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 | CT 000750
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License Number State | CT
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