Provider Demographics
NPI:1508160722
Name:DOCK, MAGGIE ESTELLE (MA, DRCC)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ESTELLE
Last Name:DOCK
Suffix:
Gender:F
Credentials:MA, DRCC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:ESTELLE
Other - Last Name:SHAVER-DOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BANK ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3430
Mailing Address - Country:US
Mailing Address - Phone:800-927-5108
Mailing Address - Fax:800-927-5108
Practice Address - Street 1:1 BANK ST
Practice Address - Street 2:SUITE 207
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3430
Practice Address - Country:US
Practice Address - Phone:800-927-5108
Practice Address - Fax:800-927-5108
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ835101Y00000X
NJ644309101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor