=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902178114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER LORNER LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2012
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 SOUTH ST STE 208A
-----------------------------------------------------
City | OYSTER BAY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11771-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-816-6888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 SEABREEZE LN
-----------------------------------------------------
City | BAYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11709-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-816-6888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 004714
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------