Provider Demographics
NPI:1568654408
Name:STORTZ, ALAN (LMHC, CADAC II)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:STORTZ
Suffix:
Gender:M
Credentials:LMHC, CADAC II
Other - Prefix:
Other - First Name:DHARMAN
Other - Middle Name:
Other - Last Name:SHAKYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, CADAC II
Mailing Address - Street 1:18 ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3302
Mailing Address - Country:US
Mailing Address - Phone:617-460-6156
Mailing Address - Fax:
Practice Address - Street 1:95 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1524
Practice Address - Country:US
Practice Address - Phone:781-596-9222
Practice Address - Fax:781-581-9876
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health