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Individual
DR. JOHN BRADLEY CARROLL
Active
Individual
DR. JOHN BRADLEY CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
NULL
103TC0700X
Clinical Psychologist
6301007077
MI
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68-0-F3-3086-0
BCBS OF MICHIGAN
MI
Enumeration date
01/30/2009
Last updated
01/30/2009
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