Provider Demographics
NPI:1629114582
Name:FAIRBANK, CARYL L (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CARYL
Middle Name:L
Last Name:FAIRBANK
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5149
Mailing Address - Country:US
Mailing Address - Phone:978-794-9441
Mailing Address - Fax:978-794-8444
Practice Address - Street 1:109 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2419
Practice Address - Country:US
Practice Address - Phone:978-794-9441
Practice Address - Fax:978-794-8444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1064021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical