Provider Demographics
NPI:1578771101
Name:ENQUIST-SCHMIDT, LORI (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ENQUIST-SCHMIDT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SILVER BAY RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2538
Mailing Address - Country:US
Mailing Address - Phone:732-255-1774
Mailing Address - Fax:
Practice Address - Street 1:725 AIRPORT ROAD
Practice Address - Street 2:PREFERRED BEHAVIORAL HEALTH OF NJ
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-8859
Practice Address - Fax:732-367-8242
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00047700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid