Provider Demographics
NPI:1598988560
Name:CARROCCIA, SHARON L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:CARROCCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4461
Mailing Address - Country:US
Mailing Address - Phone:609-652-4040
Mailing Address - Fax:609-652-5340
Practice Address - Street 1:310 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4461
Practice Address - Country:US
Practice Address - Phone:609-652-4040
Practice Address - Fax:609-652-5340
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005730001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ006075Medicare ID - Type Unspecified