MEDICARE: STEPHANIE BEVERLY CARROLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34011706A	IN

General Provider Information

NPI Number	:	1073325577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BEVERLY CARROLL

Provider Business Mailing Address
First Line	:	1827 N SPENCER AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4760
Country	:	US
Telephone Number	:	317-224-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1827 N SPENCER AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4760
Country	:	US
Telephone Number	:	317-224-6510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/23/2025

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