Healthcare Provider Details

I. General information

NPI: 1184051617
Provider Name (Legal Business Name): VINCENT L. CAROLAN LCSW, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 IDLEWOOD DR
DALLAS PA
18612-9027
US

IV. Provider business mailing address

39 IDLEWOOD DR
DALLAS PA
18612-9027
US

V. Phone/Fax

Practice location:
  • Phone: 570-706-1591
  • Fax: 570-301-6244
Mailing address:
  • Phone: 570-706-1591
  • Fax: 570-301-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007793
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019723
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: