Provider Demographics
NPI:1184286569
Name:BALTZ, LORRAINE NICOLE (LMFT)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:NICOLE
Last Name:BALTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 CORNWALLIS DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8025
Mailing Address - Country:US
Mailing Address - Phone:410-713-0264
Mailing Address - Fax:
Practice Address - Street 1:1247 S CEDAR CREST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6298
Practice Address - Country:US
Practice Address - Phone:610-770-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist