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General NPI Number Information
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NPI Number | 1295066421
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Entity Type | Individual
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Provider Name | MARY ANNE CORNELL LOUIS LPC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 1200 EAST RIDGEWOOD AVENUE 2ND FLOOR WEST WING, SUITE 213
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City | RIDGWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-665-5943
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Fax |
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Provider Business Mailing Address
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Address Line | 18 RANDOLPH PL
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4223
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Country | US
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Telephone | 210-638-0588
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Fax | 201-670-1085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37PC00395400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00395400
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License Number State | NJ
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