Provider Demographics
NPI:1568496644
Name:CARR, CAROL L
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 LIBERTY LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9017
Mailing Address - Country:US
Mailing Address - Phone:610-821-9422
Mailing Address - Fax:610-820-6308
Practice Address - Street 1:4949 LIBERTY LN
Practice Address - Street 2:SUITE 5
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9017
Practice Address - Country:US
Practice Address - Phone:610-821-9422
Practice Address - Fax:610-820-6308
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC 001259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA534087OtherVALUE OPTIONS
PA576006000OtherMAGELLAN
PA1663381OtherAMERIHEALTH
PA353221OtherMANAGED HEALTH NETWORK
PA50025746OtherCAPITAL BLUE CROSS
PA230382OtherUBH
PA7760554OtherAETNA