Provider Demographics
NPI:1972729341
Name:JOHNSON-ROSA, LOREN S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:S
Last Name:JOHNSON-ROSA
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 1:509 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5842
Mailing Address - Country:US
Mailing Address - Phone:609-871-1497
Mailing Address - Fax:609-888-0299
Practice Address - Street 1:741 MOUNT LUCAS RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1911
Practice Address - Country:US
Practice Address - Phone:609-497-2640
Practice Address - Fax:609-497-3324
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052777001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical