1003137860 NPI number — LORIANNE LODUCA M.ED, BCBA, LABA

Table of content: LORIANNE LODUCA M.ED, BCBA, LABA (NPI 1003137860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003137860 NPI number — LORIANNE LODUCA M.ED, BCBA, LABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LODUCA
Provider First Name:
LORIANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED, BCBA, LABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
LORIANNE
Provider Other Middle Name:
LODUCA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003137860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 PACELLA PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDOLPH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-597-2710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 DRUM HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-710-6837
Provider Business Practice Location Address Fax Number:
978-710-6941
Provider Enumeration Date:
06/16/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 042197449 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".