Provider Demographics
NPI:1629197272
Name:STAFFORD, CAROLE A (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:A
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CAROLE
Other - Middle Name:A
Other - Last Name:WESTLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5275 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:#124
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2918
Mailing Address - Country:US
Mailing Address - Phone:952-835-7130
Mailing Address - Fax:952-831-1783
Practice Address - Street 1:5275 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:#124
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2918
Practice Address - Country:US
Practice Address - Phone:952-835-7130
Practice Address - Fax:952-831-1783
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLICSW 0001691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical