Healthcare Provider Details

I. General information

NPI: 1336578921
Provider Name (Legal Business Name): RACHEL ANNE CARROLL BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 LINCOLN STREET
WORCESTER MA
01605
US

IV. Provider business mailing address

10 MECHANIC STREET SUITE 302
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-854-3320
  • Fax: 508-854-3328
Mailing address:
  • Phone: 508-792-5400
  • Fax: 508-831-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLMHC10214
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10214
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: