Provider Demographics
NPI:1447393392
Name:CAROL S. MCCREA, PH.D., PA
Entity Type:Organization
Organization Name:CAROL S. MCCREA, PH.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-704-0770
Mailing Address - Street 1:27 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5605
Mailing Address - Country:US
Mailing Address - Phone:908-704-0770
Mailing Address - Fax:908-279-7948
Practice Address - Street 1:27 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5605
Practice Address - Country:US
Practice Address - Phone:908-704-0770
Practice Address - Fax:908-279-7948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00372200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027051Medicare PIN