Provider Demographics
NPI:1508476698
Name:CARROLL, EMILY ROSE (MSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MASSACHUSETTS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3750
Mailing Address - Country:US
Mailing Address - Phone:978-264-3500
Mailing Address - Fax:
Practice Address - Street 1:360 MASSACHUSETTS AVE STE 103
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3750
Practice Address - Country:US
Practice Address - Phone:978-264-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical