Healthcare Provider Details

I. General information

NPI: 1194132720
Provider Name (Legal Business Name): MARY F DASHIELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DEANS RHODE HALL RD
MONMOUTH JCT NJ
08852
US

IV. Provider business mailing address

15 DEANS RHODE HALL RD
MONMOUTH JCT NJ
08852-3021
US

V. Phone/Fax

Practice location:
  • Phone: 732-543-4211
  • Fax:
Mailing address:
  • Phone: 732-543-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05344800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05533800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: