=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447300280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ANA ISABEL DU BOIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 SUSSEX TURNPIKE SUITE 104B
-----------------------------------------------------
City | RANDOLPH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-895-9955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 33
-----------------------------------------------------
City | MT FREEDOM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-895-9955
-----------------------------------------------------
Fax | 973-895-7704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 37F100758800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------