Provider Demographics
NPI:1851431530
Name:DENVER BASIL, LORE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORE
Middle Name:
Last Name:DENVER BASIL
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 1:33 W ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401
Mailing Address - Country:US
Mailing Address - Phone:201-327-8515
Mailing Address - Fax:201-327-8642
Practice Address - Street 1:33 W ORCHARD ST
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401
Practice Address - Country:US
Practice Address - Phone:201-327-8515
Practice Address - Fax:201-327-8642
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLCSW44SC074238001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY634633Medicare ID - Type Unspecified
NJ634633Medicare ID - Type Unspecified