Provider Demographics
NPI:1174912877
Name:LACORTE, MALLORY (LAC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:LACORTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JUMPING BROOK RD
Mailing Address - Street 2:BUILDING 5, SUITE 2
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2634
Mailing Address - Country:US
Mailing Address - Phone:732-643-4400
Mailing Address - Fax:
Practice Address - Street 1:1200 JUMPING BROOK RD
Practice Address - Street 2:BUILDING 5, SUITE 2
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2634
Practice Address - Country:US
Practice Address - Phone:732-643-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor