Provider Demographics
NPI:1598993693
Name:CALDWELL, CLARE M (NJ STATE CERTIFIEDMT)
Entity Type:Individual
Prefix:MS
First Name:CLARE
Middle Name:M
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:NJ STATE CERTIFIEDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 ROUTE 27
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5010
Mailing Address - Country:US
Mailing Address - Phone:732-821-8292
Mailing Address - Fax:
Practice Address - Street 1:2864 ROUTE 27 STE C
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5010
Practice Address - Country:US
Practice Address - Phone:732-821-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00025900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist