Healthcare Provider Details

I. General information

NPI: 1063636066
Provider Name (Legal Business Name): ANNMARIE IUNI-DODGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 UNION AVE BUILDING 2, SUITE 13
BRIELLE NJ
08730-1838
US

IV. Provider business mailing address

617 UNION AVE BUILDING 2, SUITE 13
BRIELLE NJ
08730-1838
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-2827
  • Fax: 732-886-2671
Mailing address:
  • Phone: 732-974-2827
  • Fax: 732-886-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: