Provider Demographics
NPI:1427189729
Name:PEARL, CAROLE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:R
Last Name:PEARL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1829
Mailing Address - Country:US
Mailing Address - Phone:201-825-0852
Mailing Address - Fax:201-825-8905
Practice Address - Street 1:1 PLAZA LN
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1829
Practice Address - Country:US
Practice Address - Phone:201-825-0852
Practice Address - Fax:201-825-8905
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100190100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ661132Medicare ID - Type Unspecified