Provider Demographics
NPI:1083123392
Name:DAUENHEIMER, KELLY ANN (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:DAUENHEIMER
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-4014
Mailing Address - Country:US
Mailing Address - Phone:973-919-5247
Mailing Address - Fax:
Practice Address - Street 1:13 ROCK RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-4014
Practice Address - Country:US
Practice Address - Phone:973-919-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06300000104100000X
COLSW.0009922172104100000X
NJ44SC061143001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker