Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 404589 | MA |
NPI | 1073027173 |
---|---|
Provider Name | Dr. Troy Douglas Carr |
First Address | Lexington, MA 02420-3900 |
Second Address | Lexington, MA 02420-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 28/11/2017 |