Provider Demographics
NPI:1558456954
Name:CARROLL, JAMES R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4254 TYLERSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8634
Mailing Address - Country:US
Mailing Address - Phone:513-874-4889
Mailing Address - Fax:513-777-8857
Practice Address - Street 1:7908 CINCINNATI DAYTON RD
Practice Address - Street 2:SUITE SA
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6602
Practice Address - Country:US
Practice Address - Phone:513-777-5500
Practice Address - Fax:513-777-8857
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3361103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000002349OtherANTHEM BLUE CROSS/BLUE SH
OH0005803022OtherAETNA