Individual
TIMOTHY D CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4779
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
(828) 586-5450
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PS01978
RI
Other
Enumeration date
12/05/2007
Last updated
09/27/2021
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