Provider Demographics
NPI:1780080374
Name:SMITH, LORRAINE
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 ASHURST LN # A
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1237
Mailing Address - Country:US
Mailing Address - Phone:160-772-0039
Mailing Address - Fax:
Practice Address - Street 1:158 ASHURST LN # A
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1237
Practice Address - Country:US
Practice Address - Phone:160-772-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2021-03-15
Deactivation Date:2018-11-12
Deactivation Code:
Reactivation Date:2021-02-24
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00742400101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional