Provider Demographics
NPI:1497935068
Name:MCCREA, CAROL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:S
Last Name:MCCREA
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 1:27 MOUNTAIN BLVD.
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2411
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:07059-2411
Practice Address - Country:US
Practice Address - Phone:908-704-0770
Practice Address - Fax:908-279-7948
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI003722103TC0700X
NJ35SI00372200103TC0700X
NJ37LC00037200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027051Medicare PIN