Provider Demographics
NPI:1710551205
Name:CARROW, NORMA JEAN
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:JEAN
Last Name:CARROW
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 1:3012 BROOKLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9244
Mailing Address - Country:US
Mailing Address - Phone:863-214-7033
Mailing Address - Fax:
Practice Address - Street 1:3012 BROOKLANDS AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9244
Practice Address - Country:US
Practice Address - Phone:863-214-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL151251041C0700X
MN297931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty