Healthcare Provider Details

I. General information

NPI: 1407240922
Provider Name (Legal Business Name): VERA CARPENTER JD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 SPRINGFIELD AVE
IRVINGTON NJ
07111-1362
US

IV. Provider business mailing address

PO BOX 221
NEWARK NJ
07101-0221
US

V. Phone/Fax

Practice location:
  • Phone: 973-399-7900
  • Fax: 973-399-1705
Mailing address:
  • Phone: 201-563-2324
  • Fax: 973-399-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number008191988
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: