Provider Demographics
NPI:1720561038
Name:SAWTELLE, CARL SALVATORE
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:SALVATORE
Last Name:SAWTELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TRACYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3501
Mailing Address - Country:US
Mailing Address - Phone:781-828-2415
Mailing Address - Fax:
Practice Address - Street 1:9 TRACYWOOD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3501
Practice Address - Country:US
Practice Address - Phone:781-828-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical