1356872782 NPI number — MS. LORRIE S YOUNG RD MS CNSC LDN

Table of content: MS. LORRIE S YOUNG RD MS CNSC LDN (NPI 1356872782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356872782 NPI number — MS. LORRIE S YOUNG RD MS CNSC LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
LORRIE
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD MS CNSC LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356872782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 SAMOSET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-7113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-930-5334
Provider Business Mailing Address Fax Number:
617-638-8599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 SAMOSET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-7113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-930-5334
Provider Business Practice Location Address Fax Number:
617-638-8599
Provider Enumeration Date:
03/27/2017

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: 133VN1006X , with the licence number:  553 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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