Provider Demographics
NPI:1598815458
Name:CARROLL, REBECCA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3000 CONNECTICUT AVE NW STE 400D
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2526
Mailing Address - Country:US
Mailing Address - Phone:202-445-7271
Mailing Address - Fax:202-332-8477
Practice Address - Street 1:3000 CONNECTICUT AVE NW STE 400D
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2526
Practice Address - Country:US
Practice Address - Phone:202-445-7271
Practice Address - Fax:202-332-8477
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1847103TC1900X, 103T00000X
MA9786103TC0700X
MD3294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC490004Medicare ID - Type Unspecified