Provider Demographics
NPI:1417675257
Name:PIDGEON, DYLAN (LCSW)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:PIDGEON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 SCHMIDT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1363
Mailing Address - Country:US
Mailing Address - Phone:732-675-0660
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST STE 314
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3905
Practice Address - Country:US
Practice Address - Phone:800-605-0612
Practice Address - Fax:800-605-0612
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060923001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical