Provider Demographics
NPI:1982615944
Name:FORLENZA, SAMUEL G (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:G
Last Name:FORLENZA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PREBLE PL
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2610
Mailing Address - Country:US
Mailing Address - Phone:201-983-1604
Mailing Address - Fax:
Practice Address - Street 1:94 VALLEY RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2211
Practice Address - Country:US
Practice Address - Phone:201-983-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4029103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist