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General NPI Number Information
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NPI Number | 1902506751
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Entity Type | Individual
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Provider Name | CARLY MAE CLEARWATER
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Gender | Female
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 1554 UNION VALLEY RD
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City | WEST MILFORD
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State | NJ
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Zip | 07480-1357
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Country | US
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Telephone | 860-575-0428
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Fax |
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Provider Business Mailing Address
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Address Line | 424 CANISTEAR RD
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City | STOCKHOLM
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State | NJ
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Zip | 07460-1832
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Country | US
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Telephone | 860-575-0428
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-320763
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 46TR00887900
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License Number State | NJ
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