Provider Demographics
NPI:1518973536
Name:BALL, CAROL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:BALL
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 1:22 MILL ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4784
Mailing Address - Country:US
Mailing Address - Phone:781-643-0610
Mailing Address - Fax:781-643-1609
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 306
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-643-0610
Practice Address - Fax:781-643-1609
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4381103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1898108Medicaid
79631OtherCIGNA PROVIDER NUMBER
MAW04244OtherBLUE CROSSBLUE SHIELD
MA1898108Medicaid