Provider Demographics
NPI:1730628256
Name:ALTRECHE, NORMA
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:ALTRECHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:ALTRECHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1825 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305
Mailing Address - Country:US
Mailing Address - Phone:201-204-0004
Mailing Address - Fax:201-915-2551
Practice Address - Street 1:1825 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305
Practice Address - Country:US
Practice Address - Phone:201-204-0004
Practice Address - Fax:201-915-2551
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043930001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC04393000OtherLICENSE CLINICAL SOCIAL WORK