Provider Demographics
NPI:1609615418
Name:CARROLL, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
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 1:300 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4103
Mailing Address - Country:US
Mailing Address - Phone:602-340-8717
Mailing Address - Fax:602-340-8720
Practice Address - Street 1:975 E WARNER RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3232
Practice Address - Country:US
Practice Address - Phone:602-340-8717
Practice Address - Fax:602-340-8720
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst