Provider Demographics
NPI:1598980641
Name:AMSELL, LOREN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:B
Last Name:AMSELL
Suffix:
Gender:F
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:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:PITTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08867-0541
Mailing Address - Country:US
Mailing Address - Phone:908-200-7791
Mailing Address - Fax:908-200-7790
Practice Address - Street 1:1200 US HIGHWAY 22
Practice Address - Street 2:SUITE 2000
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:908-203-4614
Practice Address - Fax:908-200-7790
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005728L103T00000X, 103TF0200X
NJ35S100374700103TC2200X
PAPS0005728L103TM1800X, 103T00000X
PAPS00005728L103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8042705Medicaid
NJ0117838OtherBHS
NJ0117838OtherBHS
NJ032542Medicare ID - Type Unspecified