Healthcare Provider Details

I. General information

NPI: 1114394418
Provider Name (Legal Business Name): EMILY LORIN MA, LPC, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 WHITNEY AVE
HAMDEN CT
06518-3233
US

IV. Provider business mailing address

185 ALDEN AVE FL 2
NEW HAVEN CT
06515-2109
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax:
Mailing address:
  • Phone: 678-235-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0004258
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: