Provider Demographics
NPI:1538136908
Name:MCCARROLL, BRI EIR (MSW)
Entity Type:Individual
Prefix:MS
First Name:BRI
Middle Name:EIR
Last Name:MCCARROLL
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 1:55 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1315
Mailing Address - Country:US
Mailing Address - Phone:413-746-1000
Mailing Address - Fax:413-567-7926
Practice Address - Street 1:136 DWIGHT RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1759
Practice Address - Country:US
Practice Address - Phone:413-746-1000
Practice Address - Fax:413-567-7926
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1110151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA39836OtherHEALTH NEW ENGLAND
MA1858611Medicaid
MA407332OtherMAGELLAN
MAP07947OtherBCBS
MA28743OtherBOSTON HEALTHNET
MAP22677Medicare ID - Type Unspecified