=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174147672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS NICOLE FRANCES CARON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2020
-----------------------------------------------------
Last Update Date | 07/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 CROWN COLONY DR STE 202
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-0902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-626-2523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 WEST ST UNIT 2410
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184-3868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-249-8172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 11479
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------