Provider Demographics
NPI:1235437369
Name:SHARON CARROCCIA LCSW, LLC
Entity Type:Organization
Organization Name:SHARON CARROCCIA LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARROCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-652-6040
Mailing Address - Street 1:310 CHRIS GAUPP DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4461
Mailing Address - Country:US
Mailing Address - Phone:609-652-6040
Mailing Address - Fax:609-652-5340
Practice Address - Street 1:310 CHRIS GAUPP DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4461
Practice Address - Country:US
Practice Address - Phone:609-652-6040
Practice Address - Fax:609-652-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005730001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ006075Medicare PIN