Provider Demographics
NPI:1134555410
Name:DAUER, COLLEEN PATRICIA (LSW)
Entity type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:DAUER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BIRCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2102
Mailing Address - Country:US
Mailing Address - Phone:201-327-9247
Mailing Address - Fax:201-327-9247
Practice Address - Street 1:15 BIRCHWOOD LN
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2102
Practice Address - Country:US
Practice Address - Phone:201-327-9247
Practice Address - Fax:201-327-9247
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05591900104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0OtherN/A