Provider Demographics
NPI:1902045461
Name:PRONTNICKI, DOLORES (PMHCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:
Last Name:PRONTNICKI
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:DUBOWSKY
Other - Last Name:PRONTNICKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHCNS-BC
Mailing Address - Street 1:65 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3947
Mailing Address - Country:US
Mailing Address - Phone:732-321-7189
Mailing Address - Fax:732-906-4929
Practice Address - Street 1:65 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3947
Practice Address - Country:US
Practice Address - Phone:732-321-7189
Practice Address - Fax:732-906-4929
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC05830900364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult