Provider Demographics
NPI:1255409538
Name:ISRAEL, CAROL J (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ABENAKI RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-3767
Mailing Address - Country:US
Mailing Address - Phone:978-886-2488
Mailing Address - Fax:
Practice Address - Street 1:240 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3365
Practice Address - Country:US
Practice Address - Phone:207-536-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1418103TC0700X
MA4317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical