Basic Information
| Provider Information | |||||||||
| NPI: | 1386153278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICARLO | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 SWAYZE ST | ||||||||
| Address2: | |||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070522026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085656394 | ||||||||
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| Practice Location | |||||||||
| Address1: | 312 APPLEGARTH RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MONROE TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088315347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326554239 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2017 | ||||||||
| LastUpdateDate: | 09/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 37AC00373000 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.