Provider Demographics
NPI:1669780870
Name:KILDEGAARD, CAROLYN JANE (MA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JANE
Last Name:KILDEGAARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-1385
Mailing Address - Country:US
Mailing Address - Phone:508-693-7900
Mailing Address - Fax:
Practice Address - Street 1:111 EDGARTOWN ROAD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)