Provider Demographics
NPI:1700998184
Name:MASON WHOLLEY, CAROLYN E (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:E
Last Name:MASON WHOLLEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:E
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:VA BOSTON HCS - 11PC-WHC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-5994
Mailing Address - Fax:857-364-6686
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:VA BOSTON HCS - 11PC-WHC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-5994
Practice Address - Fax:857-364-6686
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical