Healthcare Provider Details

I. General information

NPI: 1063241248
Provider Name (Legal Business Name): CARLY SHAFFER LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RIVER STREET 9TH FLOOR
HOBOKEN NJ
07030
US

IV. Provider business mailing address

111 HAVEN CT
SEWELL NJ
08080-3001
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 856-834-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06485200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00385700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: