Provider Demographics
NPI:1881924850
Name:CARROLL, PAMELA R (AMFT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:R
Last Name:CARROLL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4508
Mailing Address - Country:US
Mailing Address - Phone:773-404-4301
Mailing Address - Fax:
Practice Address - Street 1:2141 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4508
Practice Address - Country:US
Practice Address - Phone:773-404-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist