Provider Demographics
NPI:1922315936
Name:CARROLL, JAMES MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 DELAFIELD RD
Mailing Address - Street 2:BLDG. 69 (122 B-A)
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1802
Mailing Address - Country:US
Mailing Address - Phone:412-822-1302
Mailing Address - Fax:412-822-1289
Practice Address - Street 1:1010 DELAFIELD RD
Practice Address - Street 2:BLDG. 69 (122 B-A)
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-1802
Practice Address - Country:US
Practice Address - Phone:412-822-1302
Practice Address - Fax:412-822-1289
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128467104100000X
PACW0180031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker