Healthcare Provider Details

I. General information

NPI: 1750501714
Provider Name (Legal Business Name): MR. MICHAEL RICHARD DUNLEAVY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL R DUNLEAVY MSW LCSW

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 RIVER RD
FLANDERS NJ
07836
US

IV. Provider business mailing address

21 EVANS PLACE
POMPTON PLAINS NJ
07444
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-2521
  • Fax: 973-927-7529
Mailing address:
  • Phone: 973-907-2700
  • Fax: 973-839-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05311800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: