Healthcare Provider Details

I. General information

NPI: 1558799700
Provider Name (Legal Business Name): LORI DHUYVETTER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 VAN HOUTEN AVE
CLIFTON NJ
07013-2432
US

IV. Provider business mailing address

1451 VAN HOUTEN AVE
CLIFTON NJ
07013-2432
US

V. Phone/Fax

Practice location:
  • Phone: 197-347-3277
  • Fax:
Mailing address:
  • Phone: 973-473-2775
  • Fax: 973-473-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SW00071700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: