Provider Demographics
NPI:1477600443
Name:MAGNERO, CAROLYN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:MAGNERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:CARBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:859 EDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1021
Mailing Address - Country:US
Mailing Address - Phone:856-795-1680
Mailing Address - Fax:856-795-1680
Practice Address - Street 1:859 EDGE PARK DR
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1021
Practice Address - Country:US
Practice Address - Phone:917-842-4223
Practice Address - Fax:856-795-1680
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012798103TC0700X
PAPS017027103TC0700X
NJ35S100495100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
454055OtherVALUE OPTIONS
P1035277OtherOXFORD HEALTH PLAN
NY01733242Medicaid
NY01733242Medicaid