Individual
LISA CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 W 11TH RD, BROAD CHANNEL, NY 11693-1115
(347) 754-0711
Mailing address
17 W 11TH RD, BROAD CHANNEL, NY 11693-1115
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
01/09/2016
Last updated
01/09/2016
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