Provider Demographics
NPI:1154195857
Name:LOWE, LAURIE (LAC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 CLEMS RUN
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-3510
Mailing Address - Country:US
Mailing Address - Phone:856-796-2005
Mailing Address - Fax:
Practice Address - Street 1:793 CLEMS RUN
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-3510
Practice Address - Country:US
Practice Address - Phone:856-796-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00736400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist