Provider Demographics
NPI:1326292277
Name:HENTZ, CARRIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:HENTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:HENTZ
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:280 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2426
Mailing Address - Country:US
Mailing Address - Phone:973-600-0399
Mailing Address - Fax:973-429-0290
Practice Address - Street 1:280 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2426
Practice Address - Country:US
Practice Address - Phone:973-600-0399
Practice Address - Fax:973-429-0290
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001940001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical