Provider Demographics
NPI:1548472145
Name:BRODT DONNELLY, DEBORAH RENEE (MSW LCSW NJ)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:RENEE
Last Name:BRODT DONNELLY
Suffix:
Gender:F
Credentials:MSW LCSW NJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656
Mailing Address - Country:US
Mailing Address - Phone:201-307-8719
Mailing Address - Fax:
Practice Address - Street 1:284 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656
Practice Address - Country:US
Practice Address - Phone:201-307-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005991001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical