Provider Demographics
NPI:1508143991
Name:ANDERSON, CARITA MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARITA
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6701
Mailing Address - Country:US
Mailing Address - Phone:617-460-4636
Mailing Address - Fax:781-648-4349
Practice Address - Street 1:395 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6701
Practice Address - Country:US
Practice Address - Phone:617-460-4636
Practice Address - Fax:781-648-4349
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9429103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical