Provider Demographics
NPI:1659390516
Name:SPECTOR, CAROL (MED)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:SPECTOR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LOUDERS LN
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3422
Mailing Address - Country:US
Mailing Address - Phone:617-983-0999
Mailing Address - Fax:
Practice Address - Street 1:1 LOUDERS LN
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3422
Practice Address - Country:US
Practice Address - Phone:617-983-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3746101YM0800X
TX16164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA012264OtherVALUE OPTIONS
MALM0411OtherBC/BS
MA365363OtherAETNA
MA1891341Medicaid