Provider Demographics
NPI:1053554659
Name:DUNN, MARIANNE GRACE (PHD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:GRACE
Last Name:DUNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6295
Mailing Address - Country:US
Mailing Address - Phone:201-569-9667
Mailing Address - Fax:
Practice Address - Street 1:645 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6295
Practice Address - Country:US
Practice Address - Phone:201-569-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC1900X
NJ103T00000X
NYX103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist