Provider Demographics
NPI:1598515470
Name:URBANSKI, CARISSA MARIE
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:MARIE
Last Name:URBANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LAWN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3817
Mailing Address - Country:US
Mailing Address - Phone:732-351-9541
Mailing Address - Fax:
Practice Address - Street 1:121 CHANLON RD
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1543
Practice Address - Country:US
Practice Address - Phone:973-991-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00647300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional