Provider Demographics
NPI:1386846541
Name:CAROLAN, MARY-ELIZABETH (LMT, EMT-P)
Entity Type:Individual
Prefix:MS
First Name:MARY-ELIZABETH
Middle Name:
Last Name:CAROLAN
Suffix:
Gender:F
Credentials:LMT, EMT-P
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:CAROLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, EMT-P
Mailing Address - Street 1:605 US ROUTE 1
Mailing Address - Street 2:SUITE #15
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9617
Mailing Address - Country:US
Mailing Address - Phone:207-772-2113
Mailing Address - Fax:
Practice Address - Street 1:605 US ROUTE 1
Practice Address - Street 2:SUITE #15
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9617
Practice Address - Country:US
Practice Address - Phone:207-772-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME#MT491225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist