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General NPI Number Information
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NPI Number | 1740868504
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Entity Type | Individual
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Provider Name | CARLY PATTERSON LPC, LPAT
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 162 E RIDGEWOOD AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3859
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Country | US
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Telephone | 201-255-7925
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Fax |
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Provider Business Mailing Address
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Address Line | 116 GRAND AVE
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City | PARK RIDGE
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State | NJ
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Zip | 07656-1250
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Country | US
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Telephone | 201-704-6348
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00757700
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License Number State | NJ
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