Individual provider Active NPI

John-Paul Carroll, LCSW-R

  • Clinical Social Worker
  • Sayville, NY
National Provider Identifier
1467833954
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R087491
Practice address
44 Johnson Ave Apt 3C
Sayville, NY 11782-1127
Phone
(631) 972-7016
NPI assigned
Jun 10, 2015
Last updated
Oct 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R087491 Primary

Addresses

Primary practice location

44 Johnson Ave Apt 3C
Sayville, NY 11782-1127

Mailing address

PO Box 1440
Lake Grove, NY 11755-0840
Phone (631) 972-7016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200922000586 NY Practitioner - Clinical Social Worker 6103244223 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

205 Sioux St
Ronkonkoma, NY 11779-3529
Phone (631) 972-7016

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
087491NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Teladoc Health Medical Group, P.a. Clinical Current Accepting new patients
John-Paul Carroll LCSW PLLC Clinical CurrentSince Oct 9, 2022 Accepting new patients
Sunrise Counseling Center,LTD Clinical CurrentSince Aug 1, 2020 Accepting new patients
John-Paul Carroll LCSW PLLC Clinical CurrentSince Mar 23, 2024 Accepting new patients

Locations

107 W Main St
East Islip, NY 11730
Phone (631) 666-1615

Interoperability endpoints

  • Direct secure messaging: john-paulcarroll@tdh.allscriptsdirect.net

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1467833954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1440",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117550840",
            "telephone_number": "631-972-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 JOHNSON AVE APT 3C",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117821127",
            "telephone_number": "631-972-7016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JOHN-PAUL",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-10",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "R087491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sayville, NY

Sources for this page

Verify at the official NPI Registry.