Healthcare Provider Details

I. General information

NPI: 1114970613
Provider Name (Legal Business Name): CARLA DAUFENBACH L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 S GOVERNORS AVE
DOVER DE
19904-7017
US

IV. Provider business mailing address

200 EAST ST
MARYDEL DE
19964-2155
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-3225
  • Fax: 302-674-2218
Mailing address:
  • Phone: 302-492-1627
  • Fax: 302-492-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000543
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: