Provider Demographics
NPI:1538215819
Name:CARLIN, MARY JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY JANE
Middle Name:
Last Name:CARLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:CARLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:25 N DOUGHTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1811
Mailing Address - Country:US
Mailing Address - Phone:908-526-1177
Mailing Address - Fax:908-526-3139
Practice Address - Street 1:25 N DOUGHTY AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1811
Practice Address - Country:US
Practice Address - Phone:908-526-1177
Practice Address - Fax:908-526-3139
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00043200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional