Provider Demographics
NPI:1518594860
Name:GINTY, LOREN
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:GINTY
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 1:601 RIVERSIDE AVE UNIT 330
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3093
Mailing Address - Country:US
Mailing Address - Phone:203-927-3108
Mailing Address - Fax:
Practice Address - Street 1:601 RIVERSIDE AVE UNIT 330
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3093
Practice Address - Country:US
Practice Address - Phone:203-927-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty