Provider Demographics
NPI:1861710337
Name:HETHERINGTON, CAROL RUTH (LICAC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:RUTH
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HAYWARD STREET
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2166
Mailing Address - Country:US
Mailing Address - Phone:401-528-9980
Mailing Address - Fax:
Practice Address - Street 1:31 HAYWARD STREET
Practice Address - Street 2:SUITE C-2
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2166
Practice Address - Country:US
Practice Address - Phone:401-528-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245660171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist