Healthcare Provider Details

I. General information

NPI: 1154460772
Provider Name (Legal Business Name): IRENE PAONI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 MAIN ST
MATAWAN NJ
07747-3104
US

IV. Provider business mailing address

15 SILVERSMITH CT
HOWELL NJ
07731-1666
US

V. Phone/Fax

Practice location:
  • Phone: 732-290-9040
  • Fax: 732-566-0433
Mailing address:
  • Phone: 732-415-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05276300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00147000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: