Provider Demographics
NPI:1467741181
Name:CARROLL, PATRICIA M (LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-0255
Mailing Address - Country:US
Mailing Address - Phone:732-616-4250
Mailing Address - Fax:732-364-7902
Practice Address - Street 1:103 W 2ND ST STE 5
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8515
Practice Address - Country:US
Practice Address - Phone:732-534-5375
Practice Address - Fax:732-364-7902
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00307800101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1065513Medicaid
NJ0057134Medicaid