Provider Demographics
NPI:1538483581
Name:CARROLL, AMY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1616
Mailing Address - Country:US
Mailing Address - Phone:617-272-0626
Mailing Address - Fax:
Practice Address - Street 1:36 BRANDON RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-1616
Practice Address - Country:US
Practice Address - Phone:617-272-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1145001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical