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NPI Code Detail

MEDICARE: MRS. LORI PETRY MSW

MEDICARE: MRS. LORI PETRY MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC00031600NJ

General Provider Information

NPI Number : 1073663803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORI PETRY MSW
Provider Business Mailing Address
First Line : PO BOX 345
Second Line :
City : NEWTON
State : NJ
Zip : 07860-0345
Country : US
Telephone Number : 973-903-1038
Fax Number :
Provider Business Practice Location Address
First Line : 30 MORAN ST
Second Line :
City : NEWTON
State : NJ
Zip : 07860-1832
Country : US
Telephone Number : 973-903-1038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 02/08/2016

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Directions to “ MRS. LORI PETRY MSW” Practice Location

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