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Individual
TIMOTHY KEVIN CARROLL
Active
Individual
TIMOTHY KEVIN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003025
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140003025CT01
ANTHEM
CT
01
—
142613
VALUE OPTIONS
—
01
—
299867
MHN
CT
01
—
C007612
TRICARE
—
Enumeration date
09/21/2006
Last updated
10/05/2014
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