Provider Demographics
NPI:1295066421
Name:LOUIS, MARY ANNE CORNELL (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:CORNELL
Last Name:LOUIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RANDOLPH PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4223
Mailing Address - Country:US
Mailing Address - Phone:210-638-0588
Mailing Address - Fax:201-670-1085
Practice Address - Street 1:1200 EAST RIDGEWOOD AVENUE
Practice Address - Street 2:2ND FLOOR WEST WING, SUITE 213
Practice Address - City:RIDGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-665-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00395400101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor