MEDICARE: AMANDA CARROLL LCSW

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	LSW0000005580	TN

General Provider Information

NPI Number	:	1659692127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CARROLL LCSW

Provider Business Mailing Address
First Line	:	1310 24TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:	615-767-8329
Fax Number	:	615-873-7991

Provider Business Practice Location Address
First Line	:	1310 24TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:	629-772-1280
Fax Number	:	615-873-7991

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

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	04/14/2026

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