Provider Demographics
NPI:1801395603
Name:LOBUE, GILA AZAR (LSW)
Entity Type:Individual
Prefix:MS
First Name:GILA
Middle Name:AZAR
Last Name:LOBUE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HARBOR BLVD UNIT 834
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6748
Mailing Address - Country:US
Mailing Address - Phone:201-232-3863
Mailing Address - Fax:
Practice Address - Street 1:300 KIMBALL ST STE 106
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2506
Practice Address - Country:US
Practice Address - Phone:732-218-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL063208001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical