Healthcare Provider Details

I. General information

NPI: 1043532542
Provider Name (Legal Business Name): DOREEN MARION TAYLOR-SPELLER MS, LCADC, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 FRELINGHUYSEN AVE 1ST FLOOR
NEWARK NJ
07114-1349
US

IV. Provider business mailing address

687 FRELINGHUYSEN AVE 1ST FLOOR
NEWARK NJ
07114-1349
US

V. Phone/Fax

Practice location:
  • Phone: 973-799-0508
  • Fax:
Mailing address:
  • Phone: 973-799-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00197700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SW04759900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: