Provider Demographics
NPI:1871965194
Name:CARROLL, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:M
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT
Mailing Address - Street 1:42 MARCH FIELD CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6491
Mailing Address - Country:US
Mailing Address - Phone:415-246-8154
Mailing Address - Fax:
Practice Address - Street 1:42 MARCH FIELD CT
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6491
Practice Address - Country:US
Practice Address - Phone:415-246-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist