Provider Demographics
NPI:1447250139
Name:DEANE, DOUGLAS THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:THOMAS
Last Name:DEANE
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 1:1012 MERCER DRIVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3625
Mailing Address - Country:US
Mailing Address - Phone:856-547-4413
Mailing Address - Fax:
Practice Address - Street 1:832 BRUNSWICK AVE
Practice Address - Street 2:GTBHC
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608
Practice Address - Country:US
Practice Address - Phone:609-396-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC96361041C0700X
NJ44SC006626001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0988Medicare ID - Type Unspecified