Healthcare Provider Details

I. General information

NPI: 1275017444
Provider Name (Legal Business Name): LORI ZLOTOFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BARSTOW RD STE 104
GREAT NECK NY
11021-2209
US

IV. Provider business mailing address

29 BARSTOW RD STE 104
GREAT NECK NY
11021-2209
US

V. Phone/Fax

Practice location:
  • Phone: 917-538-7458
  • Fax:
Mailing address:
  • Phone: 917-538-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074471-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: