1295077469 NPI number — MS. LORRAINE DELUCIA COURTNEY LMSW

Table of content: MS. LORRAINE DELUCIA COURTNEY LMSW (NPI 1295077469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295077469 NPI number — MS. LORRAINE DELUCIA COURTNEY LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COURTNEY
Provider First Name:
LORRAINE
Provider Middle Name:
DELUCIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELUCIA-COURTNEY
Provider Other First Name:
LORRAINE
Provider Other Middle Name:
FELICIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295077469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1867 MOUNT HOPE AVE
Provider Second Line Business Mailing Address:
VA HOMELESS PROGRAM
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14620-4540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-953-2276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1867 MOUNT HOPE AVE
Provider Second Line Business Practice Location Address:
VA HOMELESS PROGRAM
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-953-2276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2013

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: 104100000X , with the licence number:  72066448 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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