Healthcare Provider Details

I. General information

NPI: 1447394093
Provider Name (Legal Business Name): JAMES EDWARD MCCARROLL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WRAMC 6900 GEORGIA AVE. NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

7508 GLENRIDDLE RD
BETHESDA MD
20817-4732
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-0065
  • Fax:
Mailing address:
  • Phone: 301-319-8003
  • Fax: 301-319-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: