Provider Demographics
NPI:1437214020
Name:FIRSICHBAUM, JUDY (MSW,LCSW,LCADC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:FIRSICHBAUM
Suffix:
Gender:F
Credentials:MSW,LCSW,LCADC
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:CARPENTIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW,LCSW,LCADC
Mailing Address - Street 1:1451 ROUTE 88
Mailing Address - Street 2:4A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2371
Mailing Address - Country:US
Mailing Address - Phone:732-785-2744
Mailing Address - Fax:732-785-3324
Practice Address - Street 1:1451 ROUTE 88
Practice Address - Street 2:4A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2371
Practice Address - Country:US
Practice Address - Phone:732-785-2744
Practice Address - Fax:732-785-3324
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00066900101YA0400X
NJ44SC045388001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS25814Medicare UPIN
NJ141847Medicare ID - Type Unspecified