Provider Demographics
NPI:1770647737
Name:SPARZO, LORI (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SPARZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1925 PENNINGTON RD
Practice Address - Street 2:22 GORDON AVENUE, LAWRENCEVILLE,NJ 08648
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1105
Practice Address - Country:US
Practice Address - Phone:609-882-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052806001041C0700X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical