Healthcare Provider Details

I. General information

NPI: 1649216433
Provider Name (Legal Business Name): ANNE LINDA HARUTUNIAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARK AVE
DUMONT NJ
07628-3004
US

IV. Provider business mailing address

45 MALCOLM ST
WALDWICK NJ
07463-2414
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-4400
  • Fax:
Mailing address:
  • Phone: 201-445-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05502500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: