Provider Demographics
NPI:1235288697
Name:PEDRO CARROLL, JOANNE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:L
Last Name:PEDRO CARROLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOANNE
Other - Middle Name:P
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2024 W HENRIETTA RD SUITE 5I
Mailing Address - Street 2:BRIGHTON CAMPUS PARK
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-292-0218
Mailing Address - Fax:585-292-0219
Practice Address - Street 1:2024 W HENRIETTA RD SUITE 5I
Practice Address - Street 2:BRIGHTON CAMPUS PARK
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-292-0218
Practice Address - Fax:585-292-0219
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0008444103T00000X
NY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist