Healthcare Provider Details

I. General information

NPI: 1164078713
Provider Name (Legal Business Name): LORI DIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SUMMER ST
HAVERHILL MA
01830-5814
US

IV. Provider business mailing address

333 BORTHWICK AVE
PORTSMOUTH NH
03801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 978-373-8222
  • Fax: 978-373-8223
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2284228
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2284228
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: