Provider Demographics
NPI:1952529513
Name:CARR, BEVERLY J (LCSW)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:CARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:J
Other - Last Name:FRENETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:121 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 GRANITE ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5730
Practice Address - Country:US
Practice Address - Phone:860-437-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140005345CT02Medicare UPIN
CT9330139Medicare UPIN
CT318570Medicare UPIN