Provider Demographics
NPI:1417079716
Name:BOBER, LORRAINE BASS (MA)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:BASS
Last Name:BOBER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4951
Mailing Address - Country:US
Mailing Address - Phone:973-243-1180
Mailing Address - Fax:973-669-8503
Practice Address - Street 1:15 CHARLES ST
Practice Address - Street 2:SUITE 6H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3011
Practice Address - Country:US
Practice Address - Phone:212-924-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37RC00000200101Y00000X
NY001141-1101YM0800X
NJ37PC00006000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional