Provider Demographics
NPI:1245704329
Name:MARTUCCI, CARIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARIN
Middle Name:
Last Name:MARTUCCI
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 1:10 W SOUTH ORANGE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1728
Mailing Address - Country:US
Mailing Address - Phone:973-688-8858
Mailing Address - Fax:
Practice Address - Street 1:10 W SOUTH ORANGE AVE FL 2
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1728
Practice Address - Country:US
Practice Address - Phone:973-688-8858
Practice Address - Fax:973-368-8859
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05264700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11719643OtherCAQH