Provider Demographics
NPI:1003039942
Name:SLIPOWITZ, CAROLE (BOTH PSYDAND LICSW)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:SLIPOWITZ
Suffix:
Gender:F
Credentials:BOTH PSYDAND LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MAYNARD ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1359
Mailing Address - Country:US
Mailing Address - Phone:617-630-0665
Mailing Address - Fax:
Practice Address - Street 1:53 LANGLEY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1913
Practice Address - Country:US
Practice Address - Phone:617-549-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6710103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist