Provider Demographics
NPI:1316488182
Name:PREUDHOMME - COSTON, DANNETTE RENEE
Entity type:Individual
Prefix:
First Name:DANNETTE
Middle Name:RENEE
Last Name:PREUDHOMME - COSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANNETTE
Other - Middle Name:
Other - Last Name:COSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:132 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1847
Mailing Address - Country:US
Mailing Address - Phone:973-876-2290
Mailing Address - Fax:
Practice Address - Street 1:132 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1847
Practice Address - Country:US
Practice Address - Phone:973-876-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00575600101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool