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General NPI Number Information
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NPI Number | 1194450882
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Entity Type | Individual
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Provider Name | CARISSA MCDONALD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 615 LACEY RD
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City | FORKED RIVER
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State | NJ
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Zip | 08731-2200
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Country | US
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Telephone | 732-908-7753
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Fax |
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Provider Business Mailing Address
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Address Line | 971 US HIGHWAY 202 N STE A
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3757
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Country | US
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Telephone | 329-087-7537
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC01119000
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License Number State | NJ
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