Provider Demographics
NPI:1073727574
Name:CARROLL, LINDA M (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:CARROLL
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 1:424 W 49TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7290
Mailing Address - Country:US
Mailing Address - Phone:212-459-3929
Mailing Address - Fax:212-459-2585
Practice Address - Street 1:424 W 49TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7290
Practice Address - Country:US
Practice Address - Phone:212-459-3929
Practice Address - Fax:212-459-2585
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008015235Z00000X
CT004032235Z00000X
PASL009312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist