Provider Demographics
NPI:1477568814
Name:FROST, CAROL ANNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNE
Last Name:FROST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:VERCOLLONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:148 MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2208
Mailing Address - Country:US
Mailing Address - Phone:781-665-8234
Mailing Address - Fax:781-665-8234
Practice Address - Street 1:61 MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-5651
Practice Address - Country:US
Practice Address - Phone:781-491-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1009341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02447Medicare UPIN
MAP02447Medicare ID - Type Unspecified