Provider Demographics
NPI:1871785717
Name:IPPOLITO, LORI (PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:IPPOLITO
Suffix:
Gender:F
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:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0599
Mailing Address - Country:US
Mailing Address - Phone:973-667-6074
Mailing Address - Fax:973-751-6074
Practice Address - Street 1:567 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1552
Practice Address - Country:US
Practice Address - Phone:973-667-6074
Practice Address - Fax:973-751-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000420001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical