Healthcare Provider Details

I. General information

NPI: 1609401249
Provider Name (Legal Business Name): AMELIA HART LOFARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 SPRING ST
LEXINGTON MA
02421-8030
US

IV. Provider business mailing address

187 SPRING ST
LEXINGTON MA
02421-8030
US

V. Phone/Fax

Practice location:
  • Phone: 781-861-7081
  • Fax: 781-861-3625
Mailing address:
  • Phone: 203-247-9901
  • Fax: 781-861-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11048
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: