Healthcare Provider Details

I. General information

NPI: 1396945382
Provider Name (Legal Business Name): MAUREEN M DESANTIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN M HOGAN LCSW

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 BEAVER DAM RD
POINT PLEASANT BORO NJ
08742-5106
US

IV. Provider business mailing address

401 OLD BRIDGE RD
BRIELLE NJ
08730-1538
US

V. Phone/Fax

Practice location:
  • Phone: 732-701-8400
  • Fax:
Mailing address:
  • Phone: 732-528-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05252100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: