Provider Demographics
NPI:1114938479
Name:MARVEL, CAROLYN DANA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN DANA
Middle Name:
Last Name:MARVEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:C. DANA
Other - Middle Name:
Other - Last Name:ST. LAURENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:23 ROWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-712-9781
Mailing Address - Fax:978-927-3724
Practice Address - Street 1:800 CUMMINGS CTR
Practice Address - Street 2:SUITE 266T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6175
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:978-927-3724
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical