Provider Demographics
NPI:1164675237
Name:DORNACKER, CINDY P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:P
Last Name:DORNACKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 KNOLLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7517
Mailing Address - Country:US
Mailing Address - Phone:848-448-6422
Mailing Address - Fax:
Practice Address - Street 1:171 KNOLLCREST AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7517
Practice Address - Country:US
Practice Address - Phone:848-448-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05291000104100000X
NJ44SC054127001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker