Provider Demographics
NPI:1134291917
Name:MAY, CAROLYN (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CUSHING AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2729
Mailing Address - Country:US
Mailing Address - Phone:617-584-3880
Mailing Address - Fax:617-484-9301
Practice Address - Street 1:1234 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1703
Practice Address - Country:US
Practice Address - Phone:617-584-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10193931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859897Medicaid
MAP05632Medicare ID - Type UnspecifiedLICSW