Provider Demographics
NPI:1487299863
Name:CARROLL PSYCHPHARMACOLOGY, LLC
Entity type:Organization
Organization Name:CARROLL PSYCHPHARMACOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:OPRE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:617-544-3671
Mailing Address - Street 1:PO BOX 4118
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02361-4118
Mailing Address - Country:US
Mailing Address - Phone:508-259-6691
Mailing Address - Fax:
Practice Address - Street 1:4 S SPOONER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4447
Practice Address - Country:US
Practice Address - Phone:617-544-3571
Practice Address - Fax:617-206-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care