| Doctor Name: | MR. JOHN CARROLL |
| NPI Number: | 1083794838 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW-R |
| License Number: | 011855 |
| Business Practice Address: | 4277 Middle Settlement Rd New Hartford, NY - 134135315 |
| Business Phone Number: | 3157356484 |
| Business Fax Number: | 3157358545 |
| Mailing Address: | 84 Old Kirkland Ave, CLINTON |
| State: | NY |
| Postal Code: | 133231435 |
| Phone Number: | 3158533268 |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 011855 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |