Provider Demographics
NPI:1992757652
Name:CARROLL, KIMBERLY FAITH (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:FAITH
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1736
Mailing Address - Country:US
Mailing Address - Phone:602-369-8129
Mailing Address - Fax:480-767-8803
Practice Address - Street 1:9755 N 90TH ST
Practice Address - Street 2:SUITE A200
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5046
Practice Address - Country:US
Practice Address - Phone:602-420-1976
Practice Address - Fax:480-767-8803
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical