Provider Demographics
NPI:1508981960
Name:WERTHEIM, LOIS LEVINE
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:LEVINE
Last Name:WERTHEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:ANN
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 FARRAGOT RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-328-1337
Mailing Address - Fax:973-328-1849
Practice Address - Street 1:130 POWERVILLE ROAD
Practice Address - Street 2:ST CLARES HOSPITAL
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005
Practice Address - Country:US
Practice Address - Phone:973-316-1905
Practice Address - Fax:973-299-5466
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01173600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker