Provider Demographics
NPI:1558497693
Name:DAHLQUIST, ELLEN RUTH (LCSW, CADC,LMFC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:RUTH
Last Name:DAHLQUIST
Suffix:
Gender:F
Credentials:LCSW, CADC,LMFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-0007
Mailing Address - Country:US
Mailing Address - Phone:908-766-9828
Mailing Address - Fax:908-766-9577
Practice Address - Street 1:61 CLAREMONT RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2200
Practice Address - Country:US
Practice Address - Phone:908-766-1221
Practice Address - Fax:908-766-9577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014869001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ675440Medicare ID - Type Unspecified