Provider Demographics
NPI:1376641506
Name:AXELROD, CAROL S (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:S
Last Name:AXELROD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 BOYLSTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3604
Mailing Address - Country:US
Mailing Address - Phone:617-266-2266
Mailing Address - Fax:617-266-6070
Practice Address - Street 1:607 BOYLSTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3604
Practice Address - Country:US
Practice Address - Phone:617-266-2266
Practice Address - Fax:617-266-6070
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1050701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical