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General NPI Number Information
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NPI Number | 1134667850
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Entity Type | Organization
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Legal Business Name | DOORWAYS OUTREACH
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 47 ROWLAND AVE
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City | CLIFTON
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State | NJ
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Zip | 07012-1234
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Country | US
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Telephone | 727-644-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 47 ROWLAND AVE
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City | CLIFTON
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State | NJ
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Zip | 07012-1234
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Country | US
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Telephone | 727-644-5755
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | VIRGINIA ANN MEINKE
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Credential | LCSW
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Telephone | 727-644-5755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW12472
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SC05695500
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License Number State | NJ
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