Healthcare Provider Details

I. General information

NPI: 1467672097
Provider Name (Legal Business Name): ELLEN M CARROLL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 EAST AVE
NORWALK CT
06851-4903
US

IV. Provider business mailing address

14 GLEN RIDGE RD
GREENWICH CT
06831-3657
US

V. Phone/Fax

Practice location:
  • Phone: 203-656-1452
  • Fax: 203-656-1485
Mailing address:
  • Phone: 203-531-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF 380919
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2605
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: