Healthcare Provider Details

I. General information

NPI: 1508010331
Provider Name (Legal Business Name): CARRIE FAYE GELMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE FAYE SHIFF MSW

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MAPLE STREET
SUMMIT NJ
07901
US

IV. Provider business mailing address

48 MAPLE STREET
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 551-580-0249
  • Fax: 908-464-4288
Mailing address:
  • Phone: 551-580-0249
  • Fax: 908-464-4288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC04786000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04786000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number44SC04786000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: