Carolyn Slack, M.S. C.G.C.

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

License

GC00005 Issued in RI

Practice address

101 Plain Street, 6TH Floor
Maternal Fetal Medicine
Providence, RI 02903-4829

Phone

(401) 274-1122

Fax

(401) 453-7622

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Affinity Physicians LLC.

  • Internal Medicine Physician
  • Warwick, RI
  • NPI 1184944662
  NPD
• Wih Faculty Practice, Inc

  • Obstetrics & Gynecology Physician
  • New Bedford, MA
  • NPI 1538113436
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1023179744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TOLL GATE RD",
            "address_2": "PRC AND CREDENTIALING",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862759",
            "telephone_number": "401-273-0641",
            "fax_number": "401-273-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PLAIN STREET, 6TH FLOOR",
            "address_2": "MATERNAL FETAL MEDICINE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034829",
            "telephone_number": "401-274-1122",
            "fax_number": "401-453-7622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "543 North St",
            "address_purpose": "LOCATION",
            "city": "New Bedford",
            "state": "MA",
            "postal_code": "027402782",
            "country_code": "US",
            "telephone_number": "508-995-2762",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Dudley St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029052401",
            "country_code": "US",
            "telephone_number": "401-453-7510",
            "fax_number": "401-453-7517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SLACK",
        "first_name": "CAROLYN",
        "credential": "M.S. C.G.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "MA",
            "license": "GC067",
            "primary": false
        },
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": "RI",
            "license": "GC00005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cslack10675@direct.carene.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "101 Dudley St",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029052401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gail Skowron, M.D.
• SKR Psychotherapy, LLC
• Caroline Skudlarek, DO
• Boris Skurkovich, MD
• Nissa Slachek
• Tara A Slack, OTR L
• Jeffrey M. Slaiby, MD
• John Slate-Romano
• Ellen Jane Slater, N.P.
• Shahrzad Ehdaivand Slater, MD, MPH

• Genetic Counselor (M.S.) in Providence, RI
• Providers in Providence, RI by specialty
• Genetic Counselor (M.S.) in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.