Provider Demographics
NPI:1659852861
Name:BITTENSON, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BITTENSON
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 1:10 CARIBOU ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1921
Mailing Address - Country:US
Mailing Address - Phone:781-275-3413
Mailing Address - Fax:
Practice Address - Street 1:10 CARIBOU ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1921
Practice Address - Country:US
Practice Address - Phone:781-275-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1036671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical