Provider Demographics
NPI:1285033589
Name:MICHELLE CARLINO
Entity Type:Organization
Organization Name:MICHELLE CARLINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARLINO
Authorized Official - Suffix:
Authorized Official - Credentials:BA/CMA
Authorized Official - Phone:609-413-6656
Mailing Address - Street 1:122 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1537
Mailing Address - Country:US
Mailing Address - Phone:609-413-6656
Mailing Address - Fax:
Practice Address - Street 1:122 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1537
Practice Address - Country:US
Practice Address - Phone:609-413-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLR35594320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities