Healthcare Provider Details

I. General information

NPI: 1629560784
Provider Name (Legal Business Name): JACQUELINE ELIZABETH CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE ELIZABETH RAMOS

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 WARREN ST APT 357
JERSEY CITY NJ
07302-7201
US

IV. Provider business mailing address

444 WARREN ST APT 357
JERSEY CITY NJ
07302-7201
US

V. Phone/Fax

Practice location:
  • Phone: 551-655-0006
  • Fax: 201-567-9335
Mailing address:
  • Phone: 551-655-0006
  • Fax: 201-567-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FA00015600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: