Healthcare Provider Details

I. General information

NPI: 1982220182
Provider Name (Legal Business Name): LORI HOTALING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10B MADISON AVENUE EXT
ALBANY NY
12203-7314
US

IV. Provider business mailing address

63 E POPLAR DR
DELMAR NY
12054-2137
US

V. Phone/Fax

Practice location:
  • Phone: 518-867-3061
  • Fax:
Mailing address:
  • Phone: 518-439-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: