MEDICARE: MS. ELLEN RUTH DAHLQUIST LCSW, CADC,LMFC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC01486900	NJ

General Provider Information

NPI Number	:	1558497693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN RUTH DAHLQUIST LCSW, CADC,LMFC

Provider Business Mailing Address
First Line	:	PO BOX 7
Second Line	:
City	:	BASKING RIDGE
State	:	NJ
Zip	:	07920-0007
Country	:	US
Telephone Number	:	908-766-9828
Fax Number	:	908-766-9577

Provider Business Practice Location Address
First Line	:	61 CLAREMONT RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2200
Country	:	US
Telephone Number	:	908-766-1221
Fax Number	:	908-766-9577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	07/08/2007

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