John Joseph Carroll III, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY29750 Issued in CA

Practice address

15235 Burbank Blvd Ste A2
Sherman Oaks, CA 91411-3555

Phone

(858) 883-3277

NPI assigned

Feb 1, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Psychologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pacific Blue Psychological Services

  • Psychologist
  • Sherman Oaks, CA
  • NPI 1124678719
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602201600000",
    "number": "1972002236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1290",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902941290",
            "fax_number": "323-978-5849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15235 BURBANK BLVD STE A2",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914113555",
            "telephone_number": "858-883-3277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3570 E Imperial Hwy",
            "address_purpose": "LOCATION",
            "city": "Lynwood",
            "state": "CA",
            "postal_code": "902622644",
            "country_code": "US",
            "telephone_number": "858-883-3277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4133 Redwood Ave Unit 1002",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900665627",
            "country_code": "US",
            "telephone_number": "858-883-3277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-01",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nayelly Lizeth Carrasco, BS, AS
• Jessica Zamira Carrillo Delgado
• Ariana Carrillo
• Karen Carrillo
• Kristine Carrillo
• Marilyn Carroll, CRNP
• Tamara Carson, LCSW
• Cassandra Carter, AMFT
• Leslie Anne Carter, PT
• Silvana Caruana

• Clinical Psychologist in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.