Provider Demographics
NPI:1407537418
Name:NER, DOREEN ETHEL (LSW)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:ETHEL
Last Name:NER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5241
Mailing Address - Country:US
Mailing Address - Phone:201-880-7530
Mailing Address - Fax:201-880-7529
Practice Address - Street 1:6 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5241
Practice Address - Country:US
Practice Address - Phone:201-880-7530
Practice Address - Fax:201-880-7529
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0566152084P0015X
NJ44SL06975600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty