Provider Demographics
NPI:1841799061
Name:LORAH-LIDESTRI, KIMBERLY MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:LORAH-LIDESTRI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:LORAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:71 COVENTRY WAY
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456
Mailing Address - Country:US
Mailing Address - Phone:201-707-6972
Mailing Address - Fax:
Practice Address - Street 1:71 COVENTRY WAY
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456
Practice Address - Country:US
Practice Address - Phone:201-707-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00033400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional