Provider Demographics
NPI:1952390999
Name:STMARTIN, CAROLYNNE J (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYNNE
Middle Name:J
Last Name:STMARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1366
Mailing Address - Country:US
Mailing Address - Phone:508-634-7799
Mailing Address - Fax:508-634-0050
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2525
Practice Address - Country:US
Practice Address - Phone:508-634-7799
Practice Address - Fax:508-634-7799
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1893009OtherMBMP
MA0501972Medicaid
MAW06137OtherBCBS
MAW06137OtherBCBS
MASTW51025Medicare ID - Type Unspecified