Provider Demographics
NPI:1366820532
Name:BARBOSA, CARLOS (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1205
Mailing Address - Country:US
Mailing Address - Phone:201-898-0777
Mailing Address - Fax:
Practice Address - Street 1:60 RIVER RD APT S202
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1531
Practice Address - Country:US
Practice Address - Phone:201-725-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06000700104100000X
NJ44SC057878001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker