Provider Demographics
NPI:1215067764
Name:GRANDE, CAREN E (LCSW)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:E
Last Name:GRANDE
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 1:1385 HIGHWAY 35 STE 274
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2012
Mailing Address - Country:US
Mailing Address - Phone:732-778-6468
Mailing Address - Fax:
Practice Address - Street 1:605 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10158-0180
Practice Address - Country:US
Practice Address - Phone:732-778-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046835001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ554239C4BMedicare ID - Type Unspecified