Provider Demographics
NPI:1245651082
Name:PIERCE-OCONNOR, DOMINIQUE VALERIE
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:VALERIE
Last Name:PIERCE-OCONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DOMINIQUE
Other - Middle Name:VALERIE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:88 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:88 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1100
Practice Address - Country:US
Practice Address - Phone:609-497-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05708100104100000X
FLSW 77641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical