Provider Demographics
NPI:1649451634
Name:WEINBERG, LORETTA SUE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:SUE
Last Name:WEINBERG
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 1:111 TROTTERS LN
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-2032
Mailing Address - Country:US
Mailing Address - Phone:201-818-1148
Mailing Address - Fax:
Practice Address - Street 1:111 TROTTERS LN
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-2032
Practice Address - Country:US
Practice Address - Phone:201-818-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000196001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ636745Medicare PIN