Provider Demographics
NPI:1336328814
Name:PEDRO, CAROL M
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:PEDRO
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 1:233 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-4005
Mailing Address - Country:US
Mailing Address - Phone:908-233-2042
Mailing Address - Fax:908-654-7414
Practice Address - Street 1:233 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-4005
Practice Address - Country:US
Practice Address - Phone:908-233-2042
Practice Address - Fax:908-654-7414
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00310800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1013071083Medicare UPIN