Healthcare Provider Details

I. General information

NPI: 1871162370
Provider Name (Legal Business Name): AMANDA S CARROLL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 HOPE ST
PROVIDENCE RI
02906-2599
US

IV. Provider business mailing address

27 ISLAND WAY
NORTH SCITUATE RI
02857-3117
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4152
  • Fax: 401-276-4571
Mailing address:
  • Phone: 401-662-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04921
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: