1083787584 NPI number — MR. MITCHELL STEPHEN DORMONT LCSW

Table of content: MR. MITCHELL STEPHEN DORMONT LCSW (NPI 1083787584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083787584 NPI number — MR. MITCHELL STEPHEN DORMONT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORMONT
Provider First Name:
MITCHELL
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083787584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 TENNET ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANALAPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-446-4122
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1961 MORRIS AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07083-5914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-686-0560
Provider Business Practice Location Address Fax Number:
908-686-5040
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC00440600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16598200 . This is a "MERIT HMO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com