Provider Demographics
NPI:1538510540
Name:MCINTOSH, CARLYN
Entity Type:Individual
Prefix:
First Name:CARLYN
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENWOODE LN APT A
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-2259
Mailing Address - Country:US
Mailing Address - Phone:313-465-3687
Mailing Address - Fax:
Practice Address - Street 1:520 BLOOMFIELD VILLAGE BLVD
Practice Address - Street 2:APT 24
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3589
Practice Address - Country:US
Practice Address - Phone:313-465-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other