Provider Demographics
NPI:1396931143
Name:CARROLL, MOLLY ANNE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANNE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:ANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9 ANGELA CIR
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4224
Mailing Address - Country:US
Mailing Address - Phone:978-337-5066
Mailing Address - Fax:
Practice Address - Street 1:500 VICTORY RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-3139
Practice Address - Country:US
Practice Address - Phone:978-337-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305638Medicaid