Provider Demographics
NPI:1497804066
Name:COLE, CAROL F (EDE)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:F
Last Name:COLE
Suffix:
Gender:F
Credentials:EDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2038
Mailing Address - Country:US
Mailing Address - Phone:617-332-0140
Mailing Address - Fax:617-630-0830
Practice Address - Street 1:73 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2038
Practice Address - Country:US
Practice Address - Phone:617-332-0140
Practice Address - Fax:617-630-0830
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical