Healthcare Provider Details

I. General information

NPI: 1326803172
Provider Name (Legal Business Name): DOREEN CONSULMAGNO LPC, LCADC, ACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOREEN COSENZA

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 TOAD LN
RINGOES NJ
08551-1022
US

IV. Provider business mailing address

31 TOAD LN
RINGOES NJ
08551-1022
US

V. Phone/Fax

Practice location:
  • Phone: 908-239-5775
  • Fax:
Mailing address:
  • Phone: 908-239-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00016100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00075400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: