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General NPI Number Information
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NPI Number | 1295092641
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Entity Type | Individual
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Provider Name | LORI ELIZABETH AZZARA PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 7 CABOT PL
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City | STOUGHTON
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State | MA
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Zip | 02072-4631
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Country | US
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Telephone | 508-930-3553
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Fax | 877-509-2367
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Provider Business Mailing Address
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Address Line | 20 ROCHE BROTHERS WAY SUITE 6-245
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City | NORTH EASTON
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State | MA
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Zip | 02356-1030
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Country | US
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Telephone | 508-930-3553
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Fax | 877-509-2367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 9436
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License Number State | MA
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