Healthcare Provider Details

I. General information

NPI: 1487252870
Provider Name (Legal Business Name): CHISLENE LORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 74TH ST FL 3
JACKSON HEIGHTS NY
11372-6338
US

IV. Provider business mailing address

3720 74TH ST FL 3
JACKSON HEIGHTS NY
11372-6338
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-9537
  • Fax:
Mailing address:
  • Phone: 212-966-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: