Healthcare Provider Details

I. General information

NPI: 1760829022
Provider Name (Legal Business Name): LORI LYN SKOROHOD LADCII, CMIP, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHIEF JUSTICE CUSHING HWY
COHASSET MA
02025-1206
US

IV. Provider business mailing address

25 CHARLES ST
WHITMAN MA
02382-2003
US

V. Phone/Fax

Practice location:
  • Phone: 781-205-0788
  • Fax:
Mailing address:
  • Phone: 781-540-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15400
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: