Individual
JONATHAN R. CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
100 CENTURY DR, WORCESTER, MA 01606
(508) 762-5400
(508) 762-5410
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
10503
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110121917A
—
MA
Enumeration date
04/26/2015
Last updated
11/21/2020
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