Provider Demographics
NPI:1124369053
Name:CARROLL, STEPHEN PAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PAUL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3410
Mailing Address - Country:US
Mailing Address - Phone:619-692-2077
Mailing Address - Fax:
Practice Address - Street 1:3909 CENTRE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3410
Practice Address - Country:US
Practice Address - Phone:619-692-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 347471041C0700X
CALCSW805101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical