Provider Demographics
NPI:1497891915
Name:CARROLL, MAUREEN ELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELLEN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 HOLLY STREET
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-839-9448
Mailing Address - Fax:713-660-6713
Practice Address - Street 1:2000 SOUTH MARKET ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833
Practice Address - Country:US
Practice Address - Phone:979-830-7170
Practice Address - Fax:979-830-7170
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20195103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0063J2OtherBLUE CROSS BLUE SHIELD
7109430000OtherMAGELLAN