MEDICARE: MRS. JANICE ELLEN DELORENZO LCSW

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
1	1041C0700X	Clinical Social Worker	44SC00488300	NJ

General Provider Information

NPI Number	:	1194800508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE ELLEN DELORENZO LCSW

Provider Business Mailing Address
First Line	:	615 BLOOMFIELD AVE
Second Line	:
City	:	NUTLEY
State	:	NJ
Zip	:	07110-1536
Country	:	US
Telephone Number	:	973-661-2916
Fax Number	:	973-661-2386

Provider Business Practice Location Address
First Line	:	543 VALLEY RD
Second Line	:	2ND FLOOR
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1881
Country	:	US
Telephone Number	:	973-768-4301
Fax Number	:	973-661-2386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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