MEDICARE: CHRISTIE CARRERA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06174900	NJ

General Provider Information

NPI Number	:	1588112262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE CARRERA LCSW

Provider Business Mailing Address
First Line	:	242 LAUREL CT
Second Line	:
City	:	WHITEHOUSE STATION
State	:	NJ
Zip	:	08889-2025
Country	:	US
Telephone Number	:	609-529-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 WILLOWBROOK BLVD STE 1103721
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7032
Country	:	US
Telephone Number	:	732-292-5711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	09/01/2023

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