Provider Demographics
NPI:1194847970
Name:MCCARROLL, JENNIFER COLLEENE (PHD, MP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COLLEENE
Last Name:MCCARROLL
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 S NORMAN C FRANCIS PKWY STE 314A
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1234
Mailing Address - Country:US
Mailing Address - Phone:504-500-1720
Mailing Address - Fax:866-606-9343
Practice Address - Street 1:1050 S NORMAN C FRANCIS PKWY STE 314A
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1234
Practice Address - Country:US
Practice Address - Phone:504-500-1720
Practice Address - Fax:866-606-9343
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323932103TP0016X
NY015469103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02379115Medicaid
NY02379115Medicaid