Provider Demographics
NPI:1841228830
Name:WOLFSON, LORRAINE (APRN)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 FRELINGHUYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-1349
Mailing Address - Country:US
Mailing Address - Phone:973-799-0508
Mailing Address - Fax:973-799-0505
Practice Address - Street 1:687 FRELINGHUYSEN AVE
Practice Address - Street 2:AMERICAN HABITARE AND COUNSELING INC
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1349
Practice Address - Country:US
Practice Address - Phone:973-799-0508
Practice Address - Fax:973-799-0505
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NCO5215400163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006602Medicaid
NJ091441AAFMedicare UPIN
NJ0006602Medicaid
NJ0006602Medicaid