Healthcare Provider Details

I. General information

NPI: 1801790167
Provider Name (Legal Business Name): MICHELLE DALLE-MOLLE MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N BEERS ST STE 1C
HOLMDEL NJ
07733-1525
US

IV. Provider business mailing address

45 W HANOVER AVE APT 1
RANDOLPH NJ
07869-4227
US

V. Phone/Fax

Practice location:
  • Phone: 732-377-2580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06373200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: