Healthcare Provider Details

I. General information

NPI: 1780646380
Provider Name (Legal Business Name): LYNNE PASTOR LCSW, LCADC,SAP,L.LC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MAIN ST SUITE 202
SUCCASUNNA NJ
07876-1400
US

IV. Provider business mailing address

54 MAIN ST SUITE 202
SUCCASUNNA NJ
07876-1400
US

V. Phone/Fax

Practice location:
  • Phone: 973-584-3020
  • Fax: 973-598-9296
Mailing address:
  • Phone: 973-584-3020
  • Fax: 973-598-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05015000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: