Provider Demographics
NPI:1306524921
Name:CARMONA, PRISCILLA J (LCSW)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:J
Last Name:CARMONA
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 1:401 WOOD RIDGE AVE # B
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1531
Mailing Address - Country:US
Mailing Address - Phone:201-893-6397
Mailing Address - Fax:
Practice Address - Street 1:638 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2306
Practice Address - Country:US
Practice Address - Phone:201-893-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062334001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical