Provider Demographics
NPI:1205346889
Name:DAMBRA, CARYN
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:DAMBRA
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 1:172 WOODPORT RD STE D
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2610
Mailing Address - Country:US
Mailing Address - Phone:973-691-3030
Mailing Address - Fax:
Practice Address - Street 1:172 WOODPORT RD STE D
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2610
Practice Address - Country:US
Practice Address - Phone:973-691-3030
Practice Address - Fax:973-691-3030
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00602200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional