Provider Demographics
NPI:1659160232
Name:CAROLLO, CARSON CAROLLO
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:CAROLLO
Last Name:CAROLLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 RACHEL BLVD FL 34607
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2529
Mailing Address - Country:US
Mailing Address - Phone:352-505-9428
Mailing Address - Fax:
Practice Address - Street 1:4245 RACHEL BLVD FL 34607
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34607-2529
Practice Address - Country:US
Practice Address - Phone:352-505-9428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician