MEDICARE: LORI MYERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	096707-1	NY
2	1041C0700X	Clinical Social Worker	088065	NY
3	104100000X	Social Worker	088065	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790211134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MYERS LCSW

Provider Business Mailing Address
First Line	:	8658 AITKEN AVE
Second Line	:
City	:	WHITESBORO
State	:	NY
Zip	:	13492
Country	:	US
Telephone Number	:	315-323-7893
Fax Number	:	315-866-3174

Provider Business Practice Location Address
First Line	:	8658 AITKEN AVE
Second Line	:
City	:	WHITESBORO
State	:	NY
Zip	:	13492-2609
Country	:	US
Telephone Number	:	315-323-7893
Fax Number	:	315-748-5367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	10/01/2020

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