Provider Demographics
NPI:1437173408
Name:MCGILL, CAROLYN ANN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:MCGILL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 RUSSELL ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3534
Mailing Address - Country:US
Mailing Address - Phone:413-992-7693
Mailing Address - Fax:
Practice Address - Street 1:234 RUSSELL ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3534
Practice Address - Country:US
Practice Address - Phone:413-992-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1077251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA800005321OtherMEDICARE RAILROAD
MA62-00198OtherEVERCARE
MA800005321OtherMEDICARE RAILROAD