Provider Demographics
NPI:1467833954
Name:CARROLL, JOHN-PAUL (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JOHN-PAUL
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-0840
Mailing Address - Country:US
Mailing Address - Phone:631-972-7016
Mailing Address - Fax:
Practice Address - Street 1:44 JOHNSON AVE APT 3C
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1127
Practice Address - Country:US
Practice Address - Phone:631-972-7016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R0874911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical