Healthcare Provider Details

I. General information

NPI: 1710618681
Provider Name (Legal Business Name): LORI PHELAN, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 BOULEVARD
POMPTON PLAINS NJ
07444-1726
US

IV. Provider business mailing address

10 SHADY TER
WAYNE NJ
07470-4320
US

V. Phone/Fax

Practice location:
  • Phone: 201-320-6334
  • Fax:
Mailing address:
  • Phone: 201-320-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI PHELAN
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 201-320-6334