Healthcare Provider Details

I. General information

NPI: 1831716653
Provider Name (Legal Business Name): ROLANDO LOZANO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3607
US

IV. Provider business mailing address

2 AUTUMN DR
MINE HILL NJ
07803-2424
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-8200
  • Fax:
Mailing address:
  • Phone: 914-525-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00934100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: