1659410066 NPI number — LORA PERREAULT LCSWR

Table of content: LORA PERREAULT LCSWR (NPI 1659410066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659410066 NPI number — LORA PERREAULT LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERREAULT
Provider First Name:
LORA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
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:
1659410066
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:
525 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14203-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-856-4494
Provider Business Mailing Address Fax Number:
716-842-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 E UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14075-5006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-681-7394
Provider Business Practice Location Address Fax Number:
716-685-9087
Provider Enumeration Date:
02/05/2007

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:  0000043939 , 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)

  • Identifier: 160743251-32 . This is a "PRISM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00030241501 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".