Provider Demographics
NPI:1366214306
Name:DIRCKS, MAGGIE
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:DIRCKS
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 1:73 COLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1803
Mailing Address - Country:US
Mailing Address - Phone:201-693-3657
Mailing Address - Fax:
Practice Address - Street 1:1401 VALLEY RD STE 303
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2074
Practice Address - Country:US
Practice Address - Phone:973-384-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00692100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health