Provider Demographics
NPI:1376433870
Name:CARROLL, MICHAEL EGGIE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EGGIE
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEACH HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-1359
Mailing Address - Country:US
Mailing Address - Phone:908-216-9167
Mailing Address - Fax:
Practice Address - Street 1:1350 CAMPUS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6841
Practice Address - Country:US
Practice Address - Phone:732-924-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00884900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health