Provider Demographics
NPI:1255562716
Name:LISZEWSKI-GODOWN, CARRIE LOUISE (MA LPC LCADC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LOUISE
Last Name:LISZEWSKI-GODOWN
Suffix:
Gender:F
Credentials:MA LPC LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-4209
Mailing Address - Country:US
Mailing Address - Phone:609-978-2269
Mailing Address - Fax:609-978-2269
Practice Address - Street 1:204 MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-4209
Practice Address - Country:US
Practice Address - Phone:609-978-2269
Practice Address - Fax:609-978-2269
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00371600101YM0800X, 101YP2500X
NJ37LC00157700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)