1891818589 NPI number — MRS. CAROL LYNN DIPAOLA LICENSED CLINICAL SO

Table of content: MRS. CAROL LYNN DIPAOLA LICENSED CLINICAL SO (NPI 1891818589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891818589 NPI number — MRS. CAROL LYNN DIPAOLA LICENSED CLINICAL SO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIPAOLA
Provider First Name:
CAROL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED CLINICAL SO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KATCHIK
Provider Other First Name:
CAROL
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW BCD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891818589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 W MAIN ST STE 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-692-0925
Provider Business Mailing Address Fax Number:
732-252-8612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 W MAIN ST STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-692-0925
Provider Business Practice Location Address Fax Number:
732-252-8612
Provider Enumeration Date:
04/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04970200 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)