Provider Demographics
NPI:1952726952
Name:MCGILLICUDDY, CAROLYNN (MS)
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:
Last Name:MCGILLICUDDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 71ST CIR APT 205
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-8947
Mailing Address - Country:US
Mailing Address - Phone:631-525-1127
Mailing Address - Fax:
Practice Address - Street 1:2740 71ST CIR APT 205
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-8947
Practice Address - Country:US
Practice Address - Phone:631-525-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health