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General NPI Number Information
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NPI Number | 1356970222
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Entity Type | Organization
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Legal Business Name | EDWARD J. LOFTUS MA LLP
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 50 FILER ST STE 210G
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City | MANISTEE
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State | MI
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Zip | 49660-2787
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Country | US
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Telephone | 231-398-0349
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Fax |
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Provider Business Mailing Address
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Address Line | 50 FILER ST STE 210G
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City | MANISTEE
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State | MI
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Zip | 49660-2787
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Country | US
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Telephone | 231-398-0349
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | EDWARD J. LOFTUS
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Credential | M.A. LLP
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Telephone | 223-398-0349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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