Provider Demographics
NPI:1871795310
Name:HALEY, DULCE BOLIVAR (LCSW BCD)
Entity type:Individual
Prefix:MS
First Name:DULCE
Middle Name:BOLIVAR
Last Name:HALEY
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:MS
Other - First Name:DULCE
Other - Middle Name:M
Other - Last Name:BOLIVAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:49 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-338-6647
Mailing Address - Fax:973-338-7285
Practice Address - Street 1:49 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-338-6647
Practice Address - Fax:973-338-7285
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014510001041C0700X
NJ37F100040600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
638949Medicare ID - Type Unspecified