Provider Demographics
NPI:1821323395
Name:ELLIOT, LORI BETH
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELLIOT
Other - Last Name:MACHLUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:154 US HIGHWAY 206
Mailing Address - Street 2:STE 6
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2051
Mailing Address - Country:US
Mailing Address - Phone:908-277-8900
Mailing Address - Fax:
Practice Address - Street 1:154 US HIGHWAY 206
Practice Address - Street 2:SUITE 6
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2051
Practice Address - Country:US
Practice Address - Phone:609-217-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00255000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health