Individual
CARLY LANDICINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
855 SOMERSET AVE, LAKEWOOD, NJ 08701-2127
(732) 905-3500
Mailing address
PO BOX 2036, LAKEWOOD, NJ 08701-8036
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06901600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
02/17/2023
Last updated
02/17/2023
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