Provider Demographics
NPI:1043532542
Name:TAYLOR-SPELLER, DOREEN MARION (MS, LCADC, CSW)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:MARION
Last Name:TAYLOR-SPELLER
Suffix:
Gender:F
Credentials:MS, LCADC, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 FRELINGHUYSEN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-1349
Mailing Address - Country:US
Mailing Address - Phone:973-799-0508
Mailing Address - Fax:
Practice Address - Street 1:687 FRELINGHUYSEN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1349
Practice Address - Country:US
Practice Address - Phone:973-799-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00197700101YA0400X
NJ44SW04759900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00197700OtherSTATE OF NJ OFFICE OF ATTORNEY GENERAL DIVISION OF CONSUMER AFFAIRS LCADC