Provider Demographics
NPI:1457861908
Name:EDWARD J. LOFTUS MA LLP
Entity Type:Organization
Organization Name:EDWARD J. LOFTUS MA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST LIMITED LICENSE
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LOFTUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:231-398-0349
Mailing Address - Street 1:50 FILER ST STE 210E
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 FILER ST STE 210E
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2787
Practice Address - Country:US
Practice Address - Phone:231-398-0934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006424251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health