Healthcare Provider Details

I. General information

NPI: 1982759882
Provider Name (Legal Business Name): YVONNE MARIE DECAROLIS MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4446 ROUTE 27
KINGSTON NJ
08528
US

IV. Provider business mailing address

73 GROVERS MILL ROAD
PLAINSBORO NJ
08536
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-4033
  • Fax:
Mailing address:
  • Phone: 609-275-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00077700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: