Provider Demographics
NPI:1851595771
Name:LOFTUS-VERGARI AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:LOFTUS-VERGARI AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CYNTHIA
Authorized Official - Last Name:LOFTUS-VERGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:570-822-9706
Mailing Address - Street 1:65 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-3100
Mailing Address - Country:US
Mailing Address - Phone:570-822-9706
Mailing Address - Fax:
Practice Address - Street 1:65 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-3100
Practice Address - Country:US
Practice Address - Phone:570-822-9706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004597-L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health