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NPI Code Detail

MEDICARE: MS. DIANNE S. CARROLL MSW, LISW-S

MEDICARE: MS. DIANNE S. CARROLL MSW, LISW-S
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
11041C0700XClinical Social WorkerI.3152-SUPVOH

General Provider Information

NPI Number : 1770878365
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANNE S. CARROLL MSW, LISW-S
Provider Business Mailing Address
First Line : 3634 HERSCHEL AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45208-1936
Country : US
Telephone Number : 513-218-3171
Fax Number :
Provider Business Practice Location Address
First Line : 1639 W NORTH BEND RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45224-2023
Country : US
Telephone Number : 513-218-3171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2011
Last Update Date : 06/13/2011

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