Healthcare Provider Details

I. General information

NPI: 1750297784
Provider Name (Legal Business Name): GINA CORFORTE LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 NJ-33
MANALAPAN NJ
07726
US

IV. Provider business mailing address

13 GALAHAD DR
MANALAPAN NJ
07726-2613
US

V. Phone/Fax

Practice location:
  • Phone: 844-910-1237
  • Fax:
Mailing address:
  • Phone: 844-910-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00256100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: