Provider Demographics
NPI:1083820567
Name:ROONEY, CAROLYN GRACE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:GRACE
Last Name:ROONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-0301
Mailing Address - Country:US
Mailing Address - Phone:973-410-0705
Mailing Address - Fax:
Practice Address - Street 1:13 MADISON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1400
Practice Address - Country:US
Practice Address - Phone:973-410-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00364800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist