Provider Demographics
NPI:1790857837
Name:MUNROE, CAROL A (RN, MS, CS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MUNROE
Suffix:
Gender:F
Credentials:RN, MS, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 APSLEY ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1615
Mailing Address - Country:US
Mailing Address - Phone:508-860-1011
Mailing Address - Fax:508-860-1068
Practice Address - Street 1:72 JAQUES AVE
Practice Address - Street 2:COMMUNITY HEALTH LINK
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2476
Practice Address - Country:US
Practice Address - Phone:508-860-1011
Practice Address - Fax:508-860-1069
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA116525OtherRN LICENSE