Provider Demographics
NPI:1881126720
Name:CARMODY, ADAM BRIAN
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:BRIAN
Last Name:CARMODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 DORCHESTER AVE # 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2426
Mailing Address - Country:US
Mailing Address - Phone:781-941-6483
Mailing Address - Fax:
Practice Address - Street 1:1861 DORCHESTER AVE # 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-2426
Practice Address - Country:US
Practice Address - Phone:781-941-6483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS33124954106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician