Provider Demographics
NPI:1255732939
Name:CARROLL, LORRAINE (CASAC-T)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CARPENTER PL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3515
Mailing Address - Country:US
Mailing Address - Phone:845-782-0295
Mailing Address - Fax:845-782-5164
Practice Address - Street 1:101 CARPENTER PL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3515
Practice Address - Country:US
Practice Address - Phone:845-782-0295
Practice Address - Fax:845-782-5164
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25708101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)