Provider Demographics
NPI:1518901594
Name:BOBBY, DOREEN J (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:J
Last Name:BOBBY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 LUDDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3225
Mailing Address - Country:US
Mailing Address - Phone:973-772-7578
Mailing Address - Fax:
Practice Address - Street 1:395 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5806
Practice Address - Country:US
Practice Address - Phone:201-646-0333
Practice Address - Fax:201-646-0334
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000192001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ657375Medicare ID - Type Unspecified