Provider Demographics
NPI:1710038138
Name:MACDONALD, CAROLYN JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEAN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BEACON ST
Mailing Address - Street 2:SUITE #245
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3282
Mailing Address - Country:US
Mailing Address - Phone:617-566-3700
Mailing Address - Fax:617-566-3738
Practice Address - Street 1:1330 BEACON ST
Practice Address - Street 2:SUITE #245
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3282
Practice Address - Country:US
Practice Address - Phone:617-566-3700
Practice Address - Fax:617-566-3738
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173709101YP2500X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult