Provider Demographics
NPI:1437734548
Name:DORAN, MARIS PASQUALE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIS
Middle Name:PASQUALE
Last Name:DORAN
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 1:5 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2117
Mailing Address - Country:US
Mailing Address - Phone:717-329-9782
Mailing Address - Fax:
Practice Address - Street 1:45 RIVER RD STE 4
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1452
Practice Address - Country:US
Practice Address - Phone:973-218-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730772101041C0700X
NJ44SC055951001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical