Provider Demographics
NPI:1447300280
Name:DU BOIS, ANA ISABEL
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:ISABEL
Last Name:DU BOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:MT FREEDOM
Mailing Address - State:NJ
Mailing Address - Zip Code:07970
Mailing Address - Country:US
Mailing Address - Phone:973-895-9955
Mailing Address - Fax:973-895-7704
Practice Address - Street 1:1201 SUSSEX TURNPIKE
Practice Address - Street 2:SUITE 104B
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-895-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100758800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist