Provider Demographics
NPI:1538357272
Name:DOORN, JEFFREY (LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:DOORN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3582
Mailing Address - Country:US
Mailing Address - Phone:201-650-2815
Mailing Address - Fax:201-438-7293
Practice Address - Street 1:460 BLOOMFIELD AVENUE
Practice Address - Street 2:SUITE 209
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:201-650-2815
Practice Address - Fax:201-438-7293
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045522001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical