Provider Demographics
NPI:1982225181
Name:CARROLL, MICHELLE MARY (CASAC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARY
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOVER VILLAGE PLAZA
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOVER PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12522
Mailing Address - Country:US
Mailing Address - Phone:845-444-2333
Mailing Address - Fax:
Practice Address - Street 1:7 DOVER VILLAGE PLAZA
Practice Address - Street 2:SUITE 2
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522
Practice Address - Country:US
Practice Address - Phone:845-444-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty