Provider Demographics
NPI:1962957092
Name:DEVIRGILIO, LORI (LSW, LCADC)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:
Last Name:DEVIRGILIO
Suffix:
Gender:F
Credentials:LSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1911
Mailing Address - Country:US
Mailing Address - Phone:732-796-3549
Mailing Address - Fax:
Practice Address - Street 1:141 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-1911
Practice Address - Country:US
Practice Address - Phone:732-796-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00225000101YA0400X
NJ44SL05807400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker