Provider Demographics
NPI:1992059679
Name:ROONEY, CAROLYN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:ROONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:881 COMMONWEALTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:978-256-1444
Mailing Address - Fax:
Practice Address - Street 1:881 COMMONWEALTH AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:978-256-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2262975163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse