=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235118332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOLORES M MINGIONE MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2006
-----------------------------------------------------
Last Update Date | 10/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 935 HWY 34, SUITES 2E SUITE 3
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-681-7183
-----------------------------------------------------
Fax | 732-441-0100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 935 HWY 34, SUITES 2E SUITE 3
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-681-7183
-----------------------------------------------------
Fax | 732-441-0100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC00747800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------