Provider Demographics
NPI:1356371090
Name:BORIS, CAROLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:BORIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2356
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48844
Mailing Address - Country:US
Mailing Address - Phone:517-545-4877
Mailing Address - Fax:
Practice Address - Street 1:701 ARGENTINE RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6827
Practice Address - Country:US
Practice Address - Phone:517-552-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062670104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
800892934OtherBCBS