Provider Demographics
NPI:1992051080
Name:GRINSTEAD, CAROLYN LEE (LICSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LEE
Last Name:GRINSTEAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BAXTER DR
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1275
Mailing Address - Country:US
Mailing Address - Phone:508-799-5756
Mailing Address - Fax:
Practice Address - Street 1:6 BAXTER DR
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1275
Practice Address - Country:US
Practice Address - Phone:508-799-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2157041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical