Provider Demographics
NPI:1831321652
Name:DUGAN, MARY T (LCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:T
Last Name:DUGAN
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:KILGANNON-DUGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:22 SILVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6337
Mailing Address - Country:US
Mailing Address - Phone:732-505-6262
Mailing Address - Fax:
Practice Address - Street 1:22 SILVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6337
Practice Address - Country:US
Practice Address - Phone:732-505-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000738001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KI634798Medicare PIN