Provider Demographics
NPI:1861548729
Name:KOLTON, CAROL R (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:KOLTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 SHACKAMAXON DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3464
Mailing Address - Country:US
Mailing Address - Phone:973-662-1776
Mailing Address - Fax:
Practice Address - Street 1:245 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1629
Practice Address - Country:US
Practice Address - Phone:973-662-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001631001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ638769Medicare ID - Type UnspecifiedEMPIRE MEDICARE PART B