Provider Demographics
NPI:1922296102
Name:FOSTER, CARLA RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:RENEE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 S HARRISON ST
Mailing Address - Street 2:APT # 6-F
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1218
Mailing Address - Country:US
Mailing Address - Phone:973-847-5625
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5305
Practice Address - Country:US
Practice Address - Phone:973-847-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100443100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical