Provider Demographics
NPI:1336156652
Name:CARROLL, ANN M (MSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 GRANITE ST
Mailing Address - Street 2:BAYRIDGE HOSPITAL
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2915
Mailing Address - Country:US
Mailing Address - Phone:781-477-6936
Mailing Address - Fax:781-477-6967
Practice Address - Street 1:60 GRANITE ST
Practice Address - Street 2:BAYRIDGE HOSPITAL
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2915
Practice Address - Country:US
Practice Address - Phone:781-477-6936
Practice Address - Fax:781-477-6967
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1046441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1202626Medicaid
MA225033Medicare ID - Type Unspecified