MEDICARE: MS. MARY V DECHRISTOFANO MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00593100	NJ

General Provider Information

NPI Number	:	1588839708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY V DECHRISTOFANO MSW, LCSW

Provider Business Mailing Address
First Line	:	287 BOULEVARD
Second Line	:
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1726
Country	:	US
Telephone Number	:	973-835-0740
Fax Number	:	973-633-8658

Provider Business Practice Location Address
First Line	:	287 BOULEVARD
Second Line	:
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1726
Country	:	US
Telephone Number	:	973-835-0740
Fax Number	:	973-633-8658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	09/17/2009

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