=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578352720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINE FU PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2025
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 186 HAMPSHIRE ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02139-1387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-401-8838
-----------------------------------------------------
Fax | 617-843-9948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 FIRST ST STE 18
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02142-1292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-401-8838
-----------------------------------------------------
Fax | 617-843-9948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. CAROLINE FU
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 713-385-4525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------