Provider Demographics
NPI:1194800508
Name:DELORENZO, JANICE ELLEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ELLEN
Last Name:DELORENZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1536
Mailing Address - Country:US
Mailing Address - Phone:973-661-2916
Mailing Address - Fax:973-661-2386
Practice Address - Street 1:543 VALLEY RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1881
Practice Address - Country:US
Practice Address - Phone:973-768-4301
Practice Address - Fax:973-661-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004883001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088718Medicare ID - Type Unspecified
NJS61711Medicare UPIN