| Dori Christmas Lcsw, Llc | |
|
70 Park St Ste 101 Montclair NJ 07042-2960 | |
| (973) 902-3775 | |
| Not Available |
| Full Name | Dori Christmas Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 70 Park St Ste 101, Montclair, New Jersey |
| Authorized Official Name and Position | Dori Legrand-christmas (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9739023775 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dori Christmas Lcsw, Llc 70 Park St Ste 101 Montclair NJ 07042-2960 Ph: (973) 902-3775 | Dori Christmas Lcsw, Llc 70 Park St Ste 101 Montclair NJ 07042-2960 Ph: (973) 902-3775 |
| NPI Number | 1649864927 |
|---|---|
| Provider Enumeration Date | 02/26/2021 |
| Last Update Date | 07/28/2022 |
| Certification Date | 07/28/2022 |
| Medicare PECOS PAC ID | 2860874849 |
|---|---|
| Medicare Enrollment ID | O20220808002162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649864927 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Dori Legrand-christmas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992300289 PECOS PAC ID: 2466834361 Enrollment ID: I20220809000243 |
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