Provider Demographics
NPI:1750715603
Name:DRISCOLL, CAREY (LICSW, MED)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:LICSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3127
Mailing Address - Country:US
Mailing Address - Phone:978-317-2992
Mailing Address - Fax:
Practice Address - Street 1:68 TREMONT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3127
Practice Address - Country:US
Practice Address - Phone:978-317-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4266911041S0200X, 101YS0200X
MA215685101YP2500X, 1041S0200X, 1041C0700X, 101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health