Provider Demographics
NPI:1285622886
Name:DAGRESS, ELISABETH B (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:B
Last Name:DAGRESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1602
Mailing Address - Country:US
Mailing Address - Phone:973-429-2982
Mailing Address - Fax:
Practice Address - Street 1:207 BELLEVUE AVE
Practice Address - Street 2:# 1
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1884
Practice Address - Country:US
Practice Address - Phone:974-744-0049
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLCSW SC043911041C0700X
NYCSW R0205291041C0700X
NJ1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool