Timothy Kevin Carroll, LCSW
Individual provider Active NPI Clinical Social Worker · North Windham, CT
NPI 1841399474 · NPPES record last updated Oct 5, 2014
Key facts
- NPI
- 1841399474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 003025 (CT)
- Practice address
- 387 Tuckie Rd
Suite D
North Windham, CT 06256-1355 - Phone
- (860) 423-4279
- Fax
- (860) 423-4284
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- University of Connecticut School of Medicine, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
387 Tuckie Rd D
North Windham, CT 06256-1355
Phone (860) 423-4279
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111111000502 | CT | Practitioner - Clinical Social Worker | 2365629771 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Partners in Counseling LLC | Clinical | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 003025 | CT | Yes |
Addresses
Primary practice location
387 Tuckie Rd
Suite D
North Windham, CT 06256-1355
Mailing address
387 Tuckie Rd
Suite D
North Windham, CT 06256-1355
Phone (860) 423-4279
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140003025CT01 | Other | CT | ANTHEM |
| C007612 | Other | TRICARE | |
| 142613 | Other | VALUE OPTIONS | |
| 299867 | Other | CT | MHN |
Other providers in North Windham, CT
- Alexandra Corriveau LLC
- Associated Dental Care of North Windham, LLC
- Marianne Roberts Carroll
- David J. Hunyady, P.C.
- Robert F Dubois
- East Coast Behavioral Health LLC
- Evidence Based Services LLC Connecticut Division
- Brandi Hernandez/ L Hernandez
All providers in North Windham, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.