Provider Demographics
NPI:1184765745
Name:LOWENTHAL, MARK S (PSY D)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:LOWENTHAL
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2119
Mailing Address - Country:US
Mailing Address - Phone:973-763-2777
Mailing Address - Fax:973-763-7271
Practice Address - Street 1:1 LENOX PLACE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2119
Practice Address - Country:US
Practice Address - Phone:973-763-2777
Practice Address - Fax:973-763-7271
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00276000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical