Provider Demographics
NPI:1629580766
Name:ASONGWED, LORECTOR NGELEFACK
Entity Type:Individual
Prefix:
First Name:LORECTOR
Middle Name:NGELEFACK
Last Name:ASONGWED
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 1:28 VIRGINIA TER
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2611
Mailing Address - Country:US
Mailing Address - Phone:781-608-4672
Mailing Address - Fax:
Practice Address - Street 1:6 PLEASANT ST.
Practice Address - Street 2:SUITE # 5
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5167
Practice Address - Country:US
Practice Address - Phone:781-480-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health