Provider Demographics
NPI:1932338159
Name:DICARLO, CHRISTINA ANNE (MA, LPC, LCADC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ANNE
Last Name:DICARLO
Suffix:
Gender:F
Credentials:MA, LPC, LCADC
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:ANNE
Other - Last Name:DELVICARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, LCADC
Mailing Address - Street 1:568 THE HIDEOUT
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-9784
Mailing Address - Country:US
Mailing Address - Phone:973-479-2297
Mailing Address - Fax:
Practice Address - Street 1:568 THE HIDEOUT
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-9784
Practice Address - Country:US
Practice Address - Phone:973-479-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00395100101YM0800X, 106H00000X
NJ37LC00171800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932338159OtherHORIZON BLUE CROSS BLUE SHIELD OF NJ