Provider Demographics
NPI:1114242419
Name:MATTISON, LORI LYNN (NBCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNN
Last Name:MATTISON
Suffix:
Gender:F
Credentials:NBCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 KINGS HWY N
Mailing Address - Street 2:SUITE 206 A
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2304
Mailing Address - Country:US
Mailing Address - Phone:215-872-8094
Mailing Address - Fax:
Practice Address - Street 1:2 SPLIT ROCK DR
Practice Address - Street 2:SUITE 6
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1244
Practice Address - Country:US
Practice Address - Phone:856-489-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00365200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional