1013089150 NPI number — DONNA J LOWRY MA LPC

Table of content: DONNA J LOWRY MA LPC (NPI 1013089150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013089150 NPI number — DONNA J LOWRY MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWRY
Provider First Name:
DONNA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PELLETIER
Provider Other First Name:
DONNA
Provider Other Middle Name:
L
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:
1013089150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SO WOODSTOCK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06267-0006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-928-9789
Provider Business Mailing Address Fax Number:
860-963-0866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 BEECHES LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SO WOODSTOCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-928-9789
Provider Business Practice Location Address Fax Number:
860-963-0866
Provider Enumeration Date:
11/14/2006

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: 103T00000X , with the licence number:  000212 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 400976 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300686 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240000212CT01 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".