Provider Demographics
NPI:1376683177
Name:DRAGO, M. CAROLE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:M. CAROLE
Middle Name:
Last Name:DRAGO
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 896
Mailing Address - Street 2:ACTON
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-0896
Mailing Address - Country:US
Mailing Address - Phone:978-884-7649
Mailing Address - Fax:
Practice Address - Street 1:114 WALTHAM ST
Practice Address - Street 2:LEXINGTON
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5415
Practice Address - Country:US
Practice Address - Phone:978-884-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10209371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10320OtherBCBS
MA329227OtherTRICARE
MA329227OtherTRICARE