Provider Demographics
NPI:1215149000
Name:CARROLL, CHARLES J (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 SPARTA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1112
Mailing Address - Country:US
Mailing Address - Phone:973-729-6333
Mailing Address - Fax:
Practice Address - Street 1:328 SPARTA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1112
Practice Address - Country:US
Practice Address - Phone:973-729-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045075001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical