Provider Demographics
NPI:1598815458
Name:CARROLL, REBECCA E (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:140 N VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9766
Mailing Address - Country:US
Mailing Address - Phone:202-445-7271
Mailing Address - Fax:202-332-8477
Practice Address - Street 1:140 N VALLEY RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:MA
Practice Address - Zip Code:01002-9766
Practice Address - Country:US
Practice Address - Phone:202-445-7271
Practice Address - Fax:202-332-8477
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1847103T00000X, 103TC1900X
MD3294103TC0700X
MA9786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC490004Medicare ID - Type Unspecified