Active NPI
Andrew Mabon Carroll, MSW
- Social Worker
- Syracuse, NY
National Provider Identifier
1003691999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- P124005
- Practice address
- 713 Harrison St
Syracuse, NY 13210-2305 - Phone
- (315) 464-3145
- NPI assigned
- Aug 29, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | P124005 | NY | Primary |
Addresses
Primary practice location
713 Harrison St
Syracuse, NY 13210-2305
Mailing address
919 E Genesee St
Syracuse, NY 13210-1739
Phone (610) 680-7259
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P124005 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693267200000",
"number": "1003691999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 E GENESEE ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101739",
"telephone_number": "610-680-7259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "713 HARRISON ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132102305",
"telephone_number": "315-464-3145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "ANDREW",
"middle_name": "MABON",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-29",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "P124005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.