Provider Demographics
NPI:1932477361
Name:CARROLL, RUBEN (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W FAYETTE ST
Mailing Address - Street 2:ROOM 533
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3403
Mailing Address - Country:US
Mailing Address - Phone:410-637-1379
Mailing Address - Fax:
Practice Address - Street 1:209 W FAYETTE ST
Practice Address - Street 2:ROOM 533
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3403
Practice Address - Country:US
Practice Address - Phone:410-637-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical