Provider Demographics
NPI:1568633097
Name:LOVELL, MAURICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:LOVELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1513
Mailing Address - Country:US
Mailing Address - Phone:201-592-1336
Mailing Address - Fax:
Practice Address - Street 1:128 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1513
Practice Address - Country:US
Practice Address - Phone:201-592-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0980000064102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0980000064OtherSTATE OF VERMONT