Provider Demographics
NPI:1154725307
Name:DAFEREDE, COLBY (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:COLBY
Middle Name:
Last Name:DAFEREDE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5304
Mailing Address - Country:US
Mailing Address - Phone:732-866-8611
Mailing Address - Fax:732-303-1221
Practice Address - Street 1:501 IRON BRIDGE RD
Practice Address - Street 2:SUITE 15
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5304
Practice Address - Country:US
Practice Address - Phone:732-866-8611
Practice Address - Fax:732-303-1221
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05883300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL05883300OtherLICENSED SOCIAL WORKER