Healthcare Provider Details

I. General information

NPI: 1013089150
Provider Name (Legal Business Name): DONNA J LOWRY MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA L PELLETIER

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BEECHES LANE
SO WOODSTOCK CT
06267
US

IV. Provider business mailing address

PO BOX 6
SO WOODSTOCK CT
06267-0006
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-9789
  • Fax: 860-963-0866
Mailing address:
  • Phone: 860-928-9789
  • Fax: 860-963-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000212
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: