Provider Demographics
NPI:1932761632
Name:HERSCHMAN, CARLY H (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:H
Last Name:HERSCHMAN
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 1:30 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2256
Mailing Address - Country:US
Mailing Address - Phone:862-432-8649
Mailing Address - Fax:
Practice Address - Street 1:2 W HANOVER AVE STE 203
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4222
Practice Address - Country:US
Practice Address - Phone:862-432-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058073001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical