Healthcare Provider Details

I. General information

NPI: 1255772364
Provider Name (Legal Business Name): DOLLY ANTONY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

IV. Provider business mailing address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

V. Phone/Fax

Practice location:
  • Phone: 201-790-6502
  • Fax:
Mailing address:
  • Phone: 201-790-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00318400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: