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General NPI Number Information
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NPI Number | 1891239414
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Entity Type | Individual
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Provider Name | HEATHER CARROLL
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Gender | Female
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 287 MIDDLESEX AVE
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City | MEDFORD
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State | MA
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Zip | 02155-5056
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Country | US
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Telephone | 781-222-3033
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Fax | 781-281-9927
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Provider Business Mailing Address
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Address Line | 101 TREMONT ST FL 6
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City | BOSTON
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State | MA
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Zip | 02108-5004
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Country | US
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Telephone | 617-804-5981
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Fax | 617-701-7740
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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 | 115365
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1875
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License Number State | NH
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