Provider Demographics
NPI:1184051617
Name:CAROLAN, VINCENT L (LCSW, LPC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:L
Last Name:CAROLAN
Suffix:
Gender:
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9027
Mailing Address - Country:US
Mailing Address - Phone:570-706-1591
Mailing Address - Fax:570-301-6244
Practice Address - Street 1:67-69 PUBLIC SQUARE, SUITE 917
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701
Practice Address - Country:US
Practice Address - Phone:570-706-1591
Practice Address - Fax:570-301-6244
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC007793101YP2500X, 101YP2500X
PACW0197231041C0700X
PA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker