Provider Demographics
NPI:1538657614
Name:CALDWELL, LORETTA G
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:G
Last Name:CALDWELL
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 1:227 DONNY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1422
Mailing Address - Country:US
Mailing Address - Phone:201-588-3491
Mailing Address - Fax:201-357-4222
Practice Address - Street 1:227 DONNY BROOK DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1422
Practice Address - Country:US
Practice Address - Phone:201-588-3491
Practice Address - Fax:201-357-4222
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051883001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical