Provider Demographics
NPI:1386153278
Name:DICARLO, LAURA (LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DICARLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SWAYZE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2026
Mailing Address - Country:US
Mailing Address - Phone:908-565-6394
Mailing Address - Fax:
Practice Address - Street 1:312 APPLEGARTH RD STE 200
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5347
Practice Address - Country:US
Practice Address - Phone:732-655-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2017-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00373000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health