Provider Demographics
NPI:1366099210
Name:MCNAMARA, CAROLINE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-3054
Mailing Address - Country:US
Mailing Address - Phone:401-369-3958
Mailing Address - Fax:
Practice Address - Street 1:45 SOCKANOSSET CROSS RD STE 100
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5529
Practice Address - Country:US
Practice Address - Phone:978-737-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-10-17
Deactivation Date:2019-08-26
Deactivation Code:
Reactivation Date:2019-10-17
Provider Licenses
StateLicense IDTaxonomies
RIOT01825225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist