Provider Demographics
NPI:1649306366
Name:CARROLL, CYNTHIA M IX
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:CARROLL
Suffix:IX
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040
Mailing Address - Country:US
Mailing Address - Phone:413-539-2480
Mailing Address - Fax:413-539-2496
Practice Address - Street 1:1233 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-539-2480
Practice Address - Fax:413-539-2496
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health