Individual
DR. CAROL ANN IVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1400 CENTRE ST, SUITE 105, NEWTON, MA 02459-2454
(617) 964-0900
(617) 965-7979
Mailing address
PO BOX 590354, NEWTON, MA 02459-0003
(617) 964-0900
(617) 965-7979
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7178
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1850377
—
MA
01
—
W05628
BLUE CROSS BLUE SHIELD
MA
Enumeration date
10/18/2006
Last updated
07/08/2007
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