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General NPI Number Information
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NPI Number | 1811084098
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Entity Type | Individual
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Provider Name | LORRAINE P SIDE MA MS RN CS APRN
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2151 DEEP CREEK RD
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City | PERKIOMENVILLE
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State | PA
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Zip | 18074
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Country | US
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Telephone | 215-541-9089
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Fax | 215-679-3144
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Provider Business Mailing Address
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Address Line | 2151 DEEP CREEK RD
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City | PERKIOMENVILLE
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State | PA
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Zip | 18074
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Country | US
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Telephone | 215-541-9089
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Fax | 215-679-3144
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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 | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | RN248822L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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