Provider Demographics
NPI:1255672234
Name:CARTER-SAGE, PATRICIA DANIELE (LPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DANIELE
Last Name:CARTER-SAGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S MAPLE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2002
Mailing Address - Country:US
Mailing Address - Phone:609-820-8274
Mailing Address - Fax:
Practice Address - Street 1:26 S MAPLE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2002
Practice Address - Country:US
Practice Address - Phone:609-820-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00112200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10001698OtherNEW JERSEY DEPARTMENT OF CHILD PROTECTION AND PERMANENCY