Provider Demographics
NPI:1336360114
Name:GLORIA LOEW
Entity Type:Organization
Organization Name:GLORIA LOEW
Other - Org Name:A CATALYST FOR CHANGE
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-871-3899
Mailing Address - Street 1:200 OLD PALISADE RD
Mailing Address - Street 2:APARTMENT 28B
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7056
Mailing Address - Country:US
Mailing Address - Phone:201-944-3394
Mailing Address - Fax:
Practice Address - Street 1:200 OLD PALISADE RD
Practice Address - Street 2:APARTMENT 28B
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7056
Practice Address - Country:US
Practice Address - Phone:201-944-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100464NMMMedicare ID - Type Unspecified