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NPI Code Detail

MEDICARE: MS. PAMELA R CARROLL AMFT

MEDICARE: MS. PAMELA R CARROLL AMFT
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1881924850
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA R CARROLL AMFT
Provider Business Mailing Address
First Line : 2141 N CLEVELAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-4508
Country : US
Telephone Number : 773-404-4301
Fax Number :
Provider Business Practice Location Address
First Line : 2141 N CLEVELAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-4508
Country : US
Telephone Number : 773-404-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2010
Last Update Date : 01/13/2010

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Directions to “ MS. PAMELA R CARROLL AMFT” Practice Location

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