=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760533467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROGER A. LAMORA ED.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 03/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 S STATION ST UNIT 5
-----------------------------------------------------
City | DUXBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02332-4534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-934-6460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 416 TEMPLE ST UNIT 5
-----------------------------------------------------
City | DUXBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02332-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-582-8075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 165
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 3453
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------