Healthcare Provider Details

I. General information

NPI: 1073987061
Provider Name (Legal Business Name): LAMORA COUNSELING ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 11/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 TEMPLE ST
DUXBURY MA
02332-3231
US

IV. Provider business mailing address

11 S STATION ST UNIT 1
DUXBURY MA
02332-4534
US

V. Phone/Fax

Practice location:
  • Phone: 603-582-8075
  • Fax:
Mailing address:
  • Phone: 603-582-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3453
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3453
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3453
License Number StateMA

VIII. Authorized Official

Name: ROGER A. LAMORA
Title or Position: PRESIDENT
Credential: ED. D.
Phone: 603-582-8075