Healthcare Provider Details

I. General information

NPI: 1477691632
Provider Name (Legal Business Name): MARION LORENZO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 RIDGEWOOD BLVD NORTH
WASHINGTON TOWNSHIP NJ
07676
US

IV. Provider business mailing address

475 RIDGEWOOD BLVD NORTH
WASHINGTON TOWNSHIP NJ
07676
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-1241
  • Fax: 201-666-1725
Mailing address:
  • Phone: 201-666-1241
  • Fax: 201-666-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC00481000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: