Provider Demographics
NPI:1992489637
Name:MIRISOLA, CAROLYN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:MIRISOLA
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 1:2 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3640
Mailing Address - Country:US
Mailing Address - Phone:781-572-1687
Mailing Address - Fax:
Practice Address - Street 1:2 BLUEBERRY LN
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3640
Practice Address - Country:US
Practice Address - Phone:781-572-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1263611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical