Provider Demographics
NPI:1114098761
Name:DAVIDSON, CAROLE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SUNNYBANK RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1325
Mailing Address - Country:US
Mailing Address - Phone:617-924-4073
Mailing Address - Fax:
Practice Address - Street 1:324 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1329
Practice Address - Country:US
Practice Address - Phone:978-664-2566
Practice Address - Fax:978-664-8023
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0893OtherMEDEX
MA461288OtherTUFTS HEALTH PLAN
MA004064OtherVALUE OPTIONS
MA043114833-07OtherPACIFICARE BEHAVIORAL HEA
MA2131778OtherCIGNA BEHAVIORAL HEALTH
MALM0893OtherBCBS OF MA
MALM0893OtherBCBS FEDERAL
MA461288OtherTUFTS BENEFIT ADMINISTRAT