Provider Demographics
NPI:1245453026
Name:PONTIUS-MOLOS, DOREEN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:MARIE
Last Name:PONTIUS-MOLOS
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 1:841 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1719
Mailing Address - Country:US
Mailing Address - Phone:201-556-1752
Mailing Address - Fax:
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3004
Practice Address - Country:US
Practice Address - Phone:201-385-4400
Practice Address - Fax:201-385-9689
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055347001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical