Provider Demographics
NPI:1780909283
Name:OTTOGALLI, CAROLYN H (LPC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:H
Last Name:OTTOGALLI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4427
Mailing Address - Country:US
Mailing Address - Phone:973-919-6712
Mailing Address - Fax:
Practice Address - Street 1:225 RT. 23 N.
Practice Address - Street 2:SUITE 2E
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419
Practice Address - Country:US
Practice Address - Phone:973-919-6712
Practice Address - Fax:973-875-2805
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC000404400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional