Provider Demographics
NPI:1396111621
Name:TOUSSAINT, CARLINE J (LMHC)
Entity type:Individual
Prefix:
First Name:CARLINE
Middle Name:J
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-3153
Mailing Address - Country:US
Mailing Address - Phone:617-657-4135
Mailing Address - Fax:
Practice Address - Street 1:914 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-3153
Practice Address - Country:US
Practice Address - Phone:617-657-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
MA11803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency