Provider Demographics
NPI:1376436451
Name:DOSSOUS, JUDIE
Entity type:Individual
Prefix:
First Name:JUDIE
Middle Name:
Last Name:DOSSOUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MAVEN
Other - Middle Name:
Other - Last Name:DOSSOUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2036
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-8036
Mailing Address - Country:US
Mailing Address - Phone:732-367-8859
Mailing Address - Fax:732-367-8242
Practice Address - Street 1:725 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5968
Practice Address - Country:US
Practice Address - Phone:732-367-8859
Practice Address - Fax:732-367-8242
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health