Provider Demographics
NPI:1467758284
Name:CARROLL, MONI A (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:MONI
Middle Name:A
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 S SUNBURY RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9345
Mailing Address - Country:US
Mailing Address - Phone:614-865-0513
Mailing Address - Fax:614-865-0513
Practice Address - Street 1:975 S SUNBURY RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-9345
Practice Address - Country:US
Practice Address - Phone:614-865-0513
Practice Address - Fax:614-865-0513
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00091111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical