MEDICARE: DIONNE MARLENE FRANK LCSW

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	44SC05646800	NJ

General Provider Information

NPI Number	:	1710420229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONNE MARLENE FRANK LCSW

Provider Business Mailing Address
First Line	:	22 SKURKA CT
Second Line	:
City	:	SAYREVILLE
State	:	NJ
Zip	:	08872-2176
Country	:	US
Telephone Number	:	201-779-1653
Fax Number	:	888-582-9030

Provider Business Practice Location Address
First Line	:	197 STATE ROUTE 18 S STE 3000
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1440
Country	:	US
Telephone Number	:	732-201-6325
Fax Number	:	888-582-9030

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

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	07/20/2018

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