Active NPI
John Bradley Carroll, PH.D.
- Clinical Child & Adolescent Psychologist
- Farmington Hills, MI
National Provider Identifier
1952549891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Practice address
- 31500 W 13 Mile Rd
#111
Farmington Hills, MI 48334-2164 - Phone
- (248) 855-9220
- Fax
- (248) 855-3866
- NPI assigned
- Jan 30, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | |||
| Clinical Psychologist | 103TC0700X | 6301007077 | MI | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | Primary |
Addresses
Primary practice location
31500 W 13 Mile Rd
#111
Farmington Hills, MI 48334-2164
Mailing address
PO Box 2689
2311 E. Stadium Blvd
Ann Arbor, MI 48106-2689
Phone (734) 761-9835
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68-0-F3-3086-0 | Other | MI | BCBS OF MICHIGAN |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301007077 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233273600000",
"number": "1952549891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2689",
"address_2": "2311 E. STADIUM BLVD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481062689",
"telephone_number": "734-761-9835",
"fax_number": "248-855-3866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31500 W 13 MILE RD",
"address_2": "#111",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483342164",
"telephone_number": "248-855-9220",
"fax_number": "248-855-3866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "JOHN",
"middle_name": "BRADLEY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-30",
"last_updated": "2009-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301007077",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "68-0-F3-3086-0",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.