Healthcare Provider Details

I. General information

NPI: 1841477262
Provider Name (Legal Business Name): CARL CHRISTIAN HERTENSTEIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 OLD MARLTON PIKE STE 101
MEDFORD NJ
08055-8772
US

IV. Provider business mailing address

103 OLD MARLTON PIKE STE 101
MEDFORD NJ
08055-8772
US

V. Phone/Fax

Practice location:
  • Phone: 856-223-2222
  • Fax:
Mailing address:
  • Phone: 856-223-2222
  • Fax: 386-788-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSW8100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberSW8100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberSW8100
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW8100
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW8100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: