Provider Demographics
NPI:1932610409
Name:LODDO, CHERYL LYNN (LCSW LCADC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:LODDO
Suffix:
Gender:F
Credentials:LCSW LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLUMBINE AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4069
Mailing Address - Country:US
Mailing Address - Phone:609-408-9102
Mailing Address - Fax:
Practice Address - Street 1:629 E WOOD ST STE 305
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3731
Practice Address - Country:US
Practice Address - Phone:856-462-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00229700101YA0400X
NJ44SC057471001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)