Provider Demographics
NPI:1265573711
Name:MARMELSTEIN, CARLA (LCSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MARMELSTEIN
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 1:32 WYOMING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1544
Mailing Address - Country:US
Mailing Address - Phone:732-363-6398
Mailing Address - Fax:
Practice Address - Street 1:APP1SP LSB PREFERRED BEHAVIORAL HEALTH OF NJ
Practice Address - Street 2:700 AIRPORT ROAD
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-4700
Practice Address - Fax:732-364-2253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047294001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical