Provider Demographics
NPI:1558477646
Name:FIORELLO, JOAN CARYN (PHD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CARYN
Last Name:FIORELLO
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 1:46 IRENE CT
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 COUNTY RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626
Practice Address - Country:US
Practice Address - Phone:201-784-0312
Practice Address - Fax:201-784-0312
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI0036100103T00000X
NY0130621103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075268Medicare PIN