Healthcare Provider Details

I. General information

NPI: 1821917469
Provider Name (Legal Business Name): ANITA CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ELM ST
WORCESTER MA
01609-2541
US

IV. Provider business mailing address

54 SIMARD DR APT 4
CHICOPEE MA
01013-3933
US

V. Phone/Fax

Practice location:
  • Phone: 413-302-4901
  • Fax:
Mailing address:
  • Phone: 413-302-4901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: