Healthcare Provider Details

I. General information

NPI: 1932322773
Provider Name (Legal Business Name): LORELLE R. HOLWAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 VALLEY HEALTH PLAZA
PARAMUS NJ
07652
US

IV. Provider business mailing address

41 HOLLAND TERRACE
TEANECK NJ
06555
US

V. Phone/Fax

Practice location:
  • Phone: 201-262-4357
  • Fax: 201-262-1698
Mailing address:
  • Phone: 201-334-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05371700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierS-4079
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMENTAL HEALTH SCREENER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: