Provider Demographics
NPI:1689750770
Name:KAROLL, BRAD R (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:R
Last Name:KAROLL
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SPARROW CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2139
Mailing Address - Country:US
Mailing Address - Phone:314-303-7721
Mailing Address - Fax:
Practice Address - Street 1:6978 CHIPPEWA ST
Practice Address - Street 2:SUITES 4 & 6
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3098
Practice Address - Country:US
Practice Address - Phone:314-303-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001744141041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical