Provider Demographics
NPI:1437671690
Name:CAMBRIDGE, LORRAINE ANN
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ANN
Last Name:CAMBRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7061
Mailing Address - Country:US
Mailing Address - Phone:347-234-3554
Mailing Address - Fax:
Practice Address - Street 1:109 LESLIE DR
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7061
Practice Address - Country:US
Practice Address - Phone:347-234-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor