Basic Information
| Provider Information | |||||||||
| NPI: | 1902942733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARR | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 PETER TUFTS RD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024741439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816410817 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 PORTER ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021282116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175693189 | ||||||||
| FaxNumber: | 6175697890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 110859 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.