Provider Demographics
NPI:1932322773
Name:HOLWAY, LORELLE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORELLE
Middle Name:R
Last Name:HOLWAY
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 1:41 HOLLAND TERRACE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:06555
Mailing Address - Country:US
Mailing Address - Phone:201-334-6054
Mailing Address - Fax:
Practice Address - Street 1:610 VALLEY HEALTH PLAZA
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-262-4357
Practice Address - Fax:201-262-1698
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053717001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS-4079OtherMENTAL HEALTH SCREENER