Provider Demographics
NPI:1891033148
Name:OUELLETTE, CAROL M (ED D, LMHC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:ED D, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2354
Mailing Address - Country:US
Mailing Address - Phone:413-271-7775
Mailing Address - Fax:413-296-2115
Practice Address - Street 1:200 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2354
Practice Address - Country:US
Practice Address - Phone:413-271-7775
Practice Address - Fax:413-296-2110
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor