Healthcare Provider Details

I. General information

NPI: 1124936513
Provider Name (Legal Business Name): LORI C SOLLOSE PSYCOTHERAPY & CLINICAL SUPERVISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 FEDERAL RD STE C35
BROOKFIELD CT
06804-2650
US

IV. Provider business mailing address

8 BONNY RD
BROOKFIELD CT
06804-3600
US

V. Phone/Fax

Practice location:
  • Phone: 914-661-0979
  • Fax:
Mailing address:
  • Phone: 914-661-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LORI C SOLLOSE
Title or Position: OWNER
Credential: LCSW
Phone: 914-661-0979