Provider Demographics
NPI:1326727538
Name:CHARLEMAGNE, CARLENE B
Entity Type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:B
Last Name:CHARLEMAGNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WASHINGTON BOULEVAES
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:347-212-0382
Mailing Address - Fax:
Practice Address - Street 1:100 LAKEVIEW AVE REAR
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-2726
Practice Address - Country:US
Practice Address - Phone:201-388-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00035900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist