Healthcare Provider Details

I. General information

NPI: 1932155108
Provider Name (Legal Business Name): LORRAINE I CARLEO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 WISCONSIN AVE NW SUITE 107
WASHINGTON DC
20016-2812
US

IV. Provider business mailing address

3805 PORTER ST NW APT 201
WASHINGTON DC
20016-2951
US

V. Phone/Fax

Practice location:
  • Phone: 202-557-0934
  • Fax:
Mailing address:
  • Phone: 315-717-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400646
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1015417
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: