Provider Demographics
NPI:1275137366
Name:CARON BIXBY LLC
Entity Type:Organization
Organization Name:CARON BIXBY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIXBY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:978-609-2235
Mailing Address - Street 1:100 CUMMINGS CTR STE 333A
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6195
Mailing Address - Country:US
Mailing Address - Phone:978-382-7250
Mailing Address - Fax:949-561-4093
Practice Address - Street 1:100 CUMMINGS CTR STE 333A
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6195
Practice Address - Country:US
Practice Address - Phone:978-382-7250
Practice Address - Fax:949-561-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty