Provider Demographics
NPI:1518560747
Name:CARROLL, MARJORIE
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
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 1:6795 SCOTTS STORE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:DE
Mailing Address - Zip Code:19950-4622
Mailing Address - Country:US
Mailing Address - Phone:302-841-5031
Mailing Address - Fax:
Practice Address - Street 1:6795 SCOTTS STORE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:DE
Practice Address - Zip Code:19950-4622
Practice Address - Country:US
Practice Address - Phone:302-841-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250568416Medicaid