Provider Demographics
NPI:1245828441
Name:DEMARCO, CAROLYN J (LPC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CJ
Other - Middle Name:
Other - Last Name:DEMARCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1393
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-1393
Mailing Address - Country:US
Mailing Address - Phone:732-403-4994
Mailing Address - Fax:
Practice Address - Street 1:172 BROADWAY STE 204
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8077
Practice Address - Country:US
Practice Address - Phone:201-580-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00734100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional