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General NPI Number Information
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NPI Number | 1487464509
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Entity Type | Individual
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Provider Name | JOHN CARROLL
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Gender | Male
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 168 CORNELL ST STE 201
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City | KINGSTON
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State | NY
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Zip | 12401-3652
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Country | US
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Telephone | 203-577-9835
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Fax | 203-577-9835
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Provider Business Mailing Address
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Address Line | PO BOX 255
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City | HOUSATONIC
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State | MA
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Zip | 01236-0255
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Country | US
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Telephone | 203-577-9835
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P133253
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License Number State | NY
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