Provider Demographics
NPI:1669361259
Name:FORT, ARIANA ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:ELIZABETH
Last Name:FORT
Suffix:
Gender:F
Credentials:LAC
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 392
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-0392
Mailing Address - Country:US
Mailing Address - Phone:908-310-9749
Mailing Address - Fax:
Practice Address - Street 1:18 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:THREE BRIDGES
Practice Address - State:NJ
Practice Address - Zip Code:08887
Practice Address - Country:US
Practice Address - Phone:908-310-9749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00835600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health