Healthcare Provider Details

I. General information

NPI: 1962092916
Provider Name (Legal Business Name): LORI M SPARZO LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 01/24/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MAPLE AVE
EWING NJ
08618-2659
US

IV. Provider business mailing address

406 MAPLE AVE
EWING NJ
08618-2659
US

V. Phone/Fax

Practice location:
  • Phone: 609-240-7020
  • Fax:
Mailing address:
  • Phone: 609-240-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI M SPARZO
Title or Position: SOLE MEMBER/OWNER
Credential: LCSW
Phone: 609-240-7020