Provider Demographics
NPI:1265824213
Name:CARBONE, KAREN ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ROSE
Last Name:CARBONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ROSE
Other - Last Name:CARBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:415 ROUTE 34
Mailing Address - Street 2:SUITE 111
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2522
Mailing Address - Country:US
Mailing Address - Phone:732-740-3632
Mailing Address - Fax:
Practice Address - Street 1:415 ROUTE 34
Practice Address - Street 2:SUITE 111
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2522
Practice Address - Country:US
Practice Address - Phone:732-740-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05779300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker