Provider Demographics
NPI:1033648076
Name:ATIBA, CHARISE (LCSW, LCADC)
Entity Type:Individual
Prefix:MS
First Name:CHARISE
Middle Name:
Last Name:ATIBA
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1948
Mailing Address - Country:US
Mailing Address - Phone:732-290-1700
Mailing Address - Fax:
Practice Address - Street 1:1088 HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1948
Practice Address - Country:US
Practice Address - Phone:732-290-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057239001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty