Healthcare Provider Details

I. General information

NPI: 1891995064
Provider Name (Legal Business Name): LAWRENCE JOHN CARROLL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 42ND ST NW SUITE 204
WASHINGTON DC
20016-4623
US

IV. Provider business mailing address

4545 42ND ST NW SUITE 204
WASHINGTON DC
20016-4623
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-1870
  • Fax: 202-537-1460
Mailing address:
  • Phone: 202-686-1870
  • Fax: 202-537-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1113
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: