Judith Ann Carroll, RI-C0908210706

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RI-C0908210706 Issued in CA

Practice address

6885 Old Hwy 53
Clearlake, CA 95422

Phone

(707) 995-3235

NPI assigned

Aug 31, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake County Community Action Agency

  dba New Beginnings

  • Community/Behavioral Health Agency
  • Clearlake, CA
  • NPI 1215125026
  NPD (past)
• Lake County Community Action Agency

  dba New Beginnings

  • Community/Behavioral Health Agency
  • Clearlake, CA
  • NPI 1669677886
  NPD (past)

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252540800000",
    "number": "1205069796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6885 OLD HWY 53",
            "address_2": "PO BOX 6470",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "95422",
            "telephone_number": "707-995-3235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6885 OLD HWY 53",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "95422",
            "telephone_number": "707-995-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JUDITH",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "RI-C0908210706",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-31",
        "last_updated": "2009-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RI-C0908210706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE DISORDER",
            "identifier": "RI-C0908210706",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Guadalupe Campos
• Jessica Victoria Cardenas
• Jeffrey S Carlton, RN CRNFA
• Susan Carreon, M.S.W.
• Ciaran George Carroll, FNP, MSN
• Melanie Irene Caruso, LVN
• Salina Lisette Castillo
• Cep America - Neurology PC
• Margaret Mary Cerbasi
• Cindy Chen

• Addiction (Substance Use Disorder) Counselor in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; 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.