Provider Demographics
NPI:1720639024
Name:CARCO, NICHOLE ALESE
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ALESE
Last Name:CARCO
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 1:17 HOWLAND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5097
Mailing Address - Country:US
Mailing Address - Phone:617-688-3304
Mailing Address - Fax:
Practice Address - Street 1:116 HELEN DR
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-1207
Practice Address - Country:US
Practice Address - Phone:781-924-1408
Practice Address - Fax:781-924-3293
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2235103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst