Provider Demographics
NPI:1083749089
Name:KRIEGER, CAROLE (LCSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 HEATHER GLEN LN
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-1767
Mailing Address - Country:US
Mailing Address - Phone:732-804-7291
Mailing Address - Fax:
Practice Address - Street 1:200 ELM ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5118
Practice Address - Country:US
Practice Address - Phone:732-804-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051934001041C0700X
SC97551041C0700X
NCC0071851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020133Medicaid
SCSW1090Medicaid