Healthcare Provider Details

I. General information

NPI: 1003294802
Provider Name (Legal Business Name): DAVID CARROLL LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GUION LN
BEDFORD NY
10506-1743
US

IV. Provider business mailing address

3 GUION LN
BEDFORD NY
10506-1743
US

V. Phone/Fax

Practice location:
  • Phone: 845-204-8262
  • Fax:
Mailing address:
  • Phone: 845-204-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: