Provider Demographics
NPI:1366623118
Name:GRAYBEAL, CAROLYN MATTHEWS (EDD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MATTHEWS
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WAVERLEY OAKS RD
Mailing Address - Street 2:BLDG. 3, SUITE 305
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8448
Mailing Address - Country:US
Mailing Address - Phone:781-894-6564
Mailing Address - Fax:781-893-5938
Practice Address - Street 1:411 WAVERLEY OAKS RD
Practice Address - Street 2:BLDG. 3, SUITE 305
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8448
Practice Address - Country:US
Practice Address - Phone:781-894-6564
Practice Address - Fax:781-893-5938
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA560235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist