Provider Demographics
NPI:1447515002
Name:LAVERY, LORRAINE MARIE (MSED)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:MARIE
Last Name:LAVERY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 GREEVES RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-3927
Mailing Address - Country:US
Mailing Address - Phone:845-416-0900
Mailing Address - Fax:
Practice Address - Street 1:464 ROUTE 17A
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1014
Practice Address - Country:US
Practice Address - Phone:845-651-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist