Individual provider Active NPI

Pamela Carroll

  • Developmental Therapist
  • Plattsburgh, NY
National Provider Identifier
1194119735
Registry record updated Mar 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental TherapistTaxonomy code 222Q00000X
Practice address
16 Degrandpre Way
Suite 200
Plattsburgh, NY 12901-6451
Phone
(518) 561-6361
NPI assigned
Mar 21, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X Primary

Addresses

Primary practice location

16 Degrandpre Way
Suite 200
Plattsburgh, NY 12901-6451

Mailing address

71 Brunell Rd
Altona, NY 12910-2402
Phone (518) 204-4112

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426896000000",
    "number": "1194119735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 BRUNELL RD",
            "city": "ALTONA",
            "state": "NY",
            "postal_code": "129102402",
            "telephone_number": "518-204-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 DEGRANDPRE WAY",
            "address_2": "SUITE 200",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129016451",
            "telephone_number": "518-561-6361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "PAMELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-21",
        "last_updated": "2015-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburgh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.