Provider Demographics
NPI:1346431152
Name:EGERTON, CARRIE A (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:EGERTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:68 BIRCH HILL RD.
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-0803
Mailing Address - Country:US
Mailing Address - Phone:413-789-0038
Mailing Address - Fax:
Practice Address - Street 1:1325 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2150
Practice Address - Country:US
Practice Address - Phone:413-789-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical