Provider Demographics
NPI:1174165732
Name:LOUTY, ANN K (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:K
Last Name:LOUTY
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 GALLOPING HILL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7980
Mailing Address - Country:US
Mailing Address - Phone:908-943-7079
Mailing Address - Fax:
Practice Address - Street 1:1050 GALLOPING HILL RD STE 205
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7980
Practice Address - Country:US
Practice Address - Phone:908-686-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician