1881734200 NPI number — MRS. CAROLYN BOYD FLEISS LICSW

Table of content: MRS. CAROLYN BOYD FLEISS LICSW (NPI 1881734200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881734200 NPI number — MRS. CAROLYN BOYD FLEISS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEISS
Provider First Name:
CAROLYN
Provider Middle Name:
BOYD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881734200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 YORK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02420-2008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-862-1535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 OLD ROAD TO 9 ACRE COR
Provider Second Line Business Practice Location Address:
COMMUNITY AGENCIES BLDG.
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-369-1113
Provider Business Practice Location Address Fax Number:
978-369-0908
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  100220 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 321840 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P10320 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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