Individual
MARY C CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSSW, LICSW
Contact information
Practice address
1000 RADIO DR, WOODBURY, MN 55125-8409
(651) 365-8209
(651) 739-0272
Mailing address
1000 RADIO DR, WOODBURY, MN 55125-8409
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9524
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108544
UCARE
MN
01
—
494S0CA
BCBS
MN
01
—
62-49483
UBH
MN
01
—
HP19174
HEALTHPARTNERS
MN
Enumeration date
10/03/2006
Last updated
07/08/2007
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