Provider Demographics
NPI:1588017826
Name:BOUMILA-VEGA, CAROLYN PATRICIA (MSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:PATRICIA
Last Name:BOUMILA-VEGA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3215
Mailing Address - Country:US
Mailing Address - Phone:617-889-7100
Mailing Address - Fax:
Practice Address - Street 1:113 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3215
Practice Address - Country:US
Practice Address - Phone:617-889-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool