Provider Demographics
NPI:1346521143
Name:GIAMBUSSO-YI, CAROLYN (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GIAMBUSSO-YI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:GIAMBUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 NEWARK AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5873
Mailing Address - Country:US
Mailing Address - Phone:201-240-6186
Mailing Address - Fax:
Practice Address - Street 1:121 NEWARK AVE STE 503
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5873
Practice Address - Country:US
Practice Address - Phone:201-240-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055670001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical