Healthcare Provider Details

I. General information

NPI: 1770647737
Provider Name (Legal Business Name): LORI SPARZO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PENNINGTON RD 22 GORDON AVENUE, LAWRENCEVILLE,NJ 08648
EWING NJ
08618-1105
US

IV. Provider business mailing address

406 MAPLE AVE
EWING NJ
08618-2659
US

V. Phone/Fax

Practice location:
  • Phone: 609-882-2288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05280600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: