Provider Demographics
NPI:1245663046
Name:BOOSE, CAROLYN E (LMSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:E
Last Name:BOOSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 14TH ST
Mailing Address - Street 2:WEST IOWA COMMUNITY MENTAL HEALTH CENTER
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2026
Mailing Address - Country:US
Mailing Address - Phone:712-263-3172
Mailing Address - Fax:712-263-5756
Practice Address - Street 1:20 N 14TH ST
Practice Address - Street 2:WEST IOWA COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2026
Practice Address - Country:US
Practice Address - Phone:712-263-3172
Practice Address - Fax:712-263-5756
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0081521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0092221Medicaid