Provider Demographics
NPI:1457558728
Name:CARROLL, DIANNE PATRICIA
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:PATRICIA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1530
Mailing Address - Country:US
Mailing Address - Phone:508-586-1820
Mailing Address - Fax:508-583-9510
Practice Address - Street 1:830 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5523
Practice Address - Country:US
Practice Address - Phone:508-586-1820
Practice Address - Fax:508-583-9510
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA84237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1543172Medicaid