Provider Demographics
NPI:1407229339
Name:CAROCCIO, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CAROCCIO
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 1:8 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1107
Practice Address - Country:US
Practice Address - Phone:609-425-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16072800390200000X
NJ26NJ01118500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program