MEDICARE: GERTRUDE CARL LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW1130434	MA

General Provider Information

NPI Number	:	1366678591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERTRUDE CARL LICSW

Provider Business Mailing Address
First Line	:	832 COLUMBIA RD APT 2
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02125-3720
Country	:	US
Telephone Number	:	484-702-2617
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 CHURCH ST
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-1624
Country	:	US
Telephone Number	:	484-702-2617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/01/2026

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Directions to “ GERTRUDE CARL LICSW” Practice Location

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