Provider Demographics
NPI:1558914390
Name:CARROLL, DEANNA LYNN (CLC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1217
Mailing Address - Country:US
Mailing Address - Phone:609-468-1429
Mailing Address - Fax:
Practice Address - Street 1:81 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1217
Practice Address - Country:US
Practice Address - Phone:609-468-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN