Provider Demographics
NPI:1154478519
Name:CARR-KAFFASHAN, LUCILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCILLE
Middle Name:
Last Name:CARR-KAFFASHAN
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 1:97 CEDAR GROVE LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1377
Mailing Address - Country:US
Mailing Address - Phone:732-469-7525
Mailing Address - Fax:
Practice Address - Street 1:97 CEDAR GROVE LN
Practice Address - Street 2:SUITE 203
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1377
Practice Address - Country:US
Practice Address - Phone:732-469-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00149500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066926Medicare PIN