Provider Demographics
NPI:1477691632
Name:LORENZO, MARION (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 RIDGEWOOD BLVD NORTH
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07676
Mailing Address - Country:US
Mailing Address - Phone:201-666-1241
Mailing Address - Fax:201-666-1725
Practice Address - Street 1:475 RIDGEWOOD BLVD NORTH
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07676
Practice Address - Country:US
Practice Address - Phone:201-666-1241
Practice Address - Fax:201-666-1725
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00481000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ646933Medicare ID - Type Unspecified