| John-paul Carroll Lcsw Pllc | |
|
205 Sioux St Ronkonkoma NY 11779-3529 | |
| (631) 972-7016 | |
| Not Available |
| Full Name | John-paul Carroll Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 205 Sioux St, Ronkonkoma, New York |
| Authorized Official Name and Position | John Paul Carroll (OWNER) |
| Authorized Official Contact | 6319727016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John-paul Carroll Lcsw Pllc 205 Sioux St Ronkonkoma NY 11779-3529 Ph: (631) 972-7016 | John-paul Carroll Lcsw Pllc 205 Sioux St Ronkonkoma NY 11779-3529 Ph: (631) 972-7016 |
| NPI Number | 1730802372 |
|---|---|
| Provider Enumeration Date | 09/20/2022 |
| Last Update Date | 09/20/2022 |
| Certification Date | 09/20/2022 |
| Medicare PECOS PAC ID | 4385084839 |
|---|---|
| Medicare Enrollment ID | O20240501000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730802372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | John-paul Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467833954 PECOS PAC ID: 6103244223 Enrollment ID: I20200922000586 |
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