Healthcare Provider Details

I. General information

NPI: 1649864927
Provider Name (Legal Business Name): DORI CHRISTMAS, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PARK ST STE 101
MONTCLAIR NJ
07042-2960
US

IV. Provider business mailing address

70 PARK ST STE 101
MONTCLAIR NJ
07042-2960
US

V. Phone/Fax

Practice location:
  • Phone: 973-902-3775
  • Fax: 973-447-3999
Mailing address:
  • Phone: 973-902-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DORI LEGRAND-CHRISTMAS
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 973-902-3775