Provider Demographics
NPI:1013715705
Name:CARROLL, ROBIN ANN (CADC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:
Credentials:CADC
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:ANN
Other - Last Name:LAVORATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC
Mailing Address - Street 1:39 WESTOVER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7712
Mailing Address - Country:US
Mailing Address - Phone:862-485-8811
Mailing Address - Fax:
Practice Address - Street 1:101 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2963
Practice Address - Country:US
Practice Address - Phone:862-485-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00189200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)