# DR. JOHN BRADLEY CARROLL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1952549891
- **Gender:** Man
- **Credential:** PH.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103G00000X | Clinical Neuropsychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | 6301007077 | MI | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |

## Other

- **Enumeration date:** 01/30/2009
- **Last updated:** 01/30/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 68-0-F3-3086-0 | BCBS OF MICHIGAN | MI |