Provider Demographics
NPI:1376152389
Name:FOREMAN, CAROLYN CHRISTINE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:CHRISTINE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-5837
Mailing Address - Country:US
Mailing Address - Phone:208-794-9678
Mailing Address - Fax:
Practice Address - Street 1:1406 CHERRY ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-5837
Practice Address - Country:US
Practice Address - Phone:208-794-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-26
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician