Provider Demographics
NPI:1407176431
Name:HARTNACK, LOIS ANN (MA, LAC, ATR-BC)
Entity Type:Individual
Prefix:MISS
First Name:LOIS
Middle Name:ANN
Last Name:HARTNACK
Suffix:
Gender:F
Credentials:MA, LAC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WICK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863
Mailing Address - Country:US
Mailing Address - Phone:732-634-2524
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY RD
Practice Address - Street 2:SUITE 12
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:732-259-5641
Practice Address - Fax:732-906-0349
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor