Provider Demographics
NPI:1427319268
Name:CARROLL, SUSAN M
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 DORAN RD
Mailing Address - Street 2:
Mailing Address - City:COPENHAGEN
Mailing Address - State:NY
Mailing Address - Zip Code:13626-3301
Mailing Address - Country:US
Mailing Address - Phone:315-408-1738
Mailing Address - Fax:
Practice Address - Street 1:21638 REED RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5048
Practice Address - Country:US
Practice Address - Phone:315-786-0677
Practice Address - Fax:315-836-3782
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator