Provider Demographics
NPI:1669832986
Name:RICHARDSON, CARLY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:SILIPINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:333 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2123
Mailing Address - Country:US
Mailing Address - Phone:856-575-5496
Mailing Address - Fax:
Practice Address - Street 1:333 IRVING AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2123
Practice Address - Country:US
Practice Address - Phone:856-575-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06104700101YA0400X
101YA0400X
NJ44SC059105001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)