Provider Demographics
NPI:1063150951
Name:CARROLL, BENJAMIN HUDDELL (PSYCHOLOGY BACHELORS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HUDDELL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PSYCHOLOGY BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ANDERS DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1001
Mailing Address - Country:US
Mailing Address - Phone:609-313-4580
Mailing Address - Fax:
Practice Address - Street 1:15 ANDERS DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1001
Practice Address - Country:US
Practice Address - Phone:609-313-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty