Provider Demographics
NPI:1992300289
Name:LEGRAND-CHRISTMAS, DORI (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DORI
Middle Name:
Last Name:LEGRAND-CHRISTMAS
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 1:70 PARK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2960
Mailing Address - Country:US
Mailing Address - Phone:973-902-3775
Mailing Address - Fax:
Practice Address - Street 1:70 PARK ST STE 101
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2960
Practice Address - Country:US
Practice Address - Phone:973-902-3775
Practice Address - Fax:973-447-3999
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058953001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0861545Medicaid