Provider Demographics
NPI:1205140134
Name:CARROLL, DAVID (LICSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 A HAVERHILL STREET
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-682-5276
Mailing Address - Fax:978-688-4932
Practice Address - Street 1:100 A HAVERHILL STREET
Practice Address - Street 2:ST. ANN'S HOME
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-682-5276
Practice Address - Fax:978-688-4932
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10193941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical