Healthcare Provider Details

I. General information

NPI: 1336124460
Provider Name (Legal Business Name): DENNIS PETER DAURIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ROUTE 517 SUITE ONE
HACKETTSTOWN NJ
07840
US

IV. Provider business mailing address

122 DANVILLE MOUNTAIN RD
GREAT MEADOWS NJ
07838
US

V. Phone/Fax

Practice location:
  • Phone: 908-797-3392
  • Fax: 908-684-8080
Mailing address:
  • Phone: 908-637-8079
  • Fax: 908-674-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04645900
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier266991000
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMAGELLAN
# 2
Identifier2151830000
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAMERIHEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: