Provider Demographics
NPI:1679981062
Name:GUDDEMI, DOREEN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:MARIE
Last Name:GUDDEMI
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 1:8 YOHN DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2151
Mailing Address - Country:US
Mailing Address - Phone:908-239-2846
Mailing Address - Fax:
Practice Address - Street 1:335 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3109
Practice Address - Country:US
Practice Address - Phone:908-239-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2021-03-15
Deactivation Date:2016-08-29
Deactivation Code:
Reactivation Date:2021-03-15
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010173001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical