Provider Demographics
NPI:1548592314
Name:CARROLL, CECELIA LEWIS (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CECELIA
Middle Name:LEWIS
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4040
Mailing Address - Country:US
Mailing Address - Phone:410-728-0163
Mailing Address - Fax:410-728-0163
Practice Address - Street 1:2504 MADISON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4040
Practice Address - Country:US
Practice Address - Phone:410-728-0163
Practice Address - Fax:410-728-0163
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD040731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical