MEDICARE: LORI D'ELIA LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1124202700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI D'ELIA LMFT

Provider Business Mailing Address
First Line	:	257 15TH ST APT 203
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-8701
Country	:	US
Telephone Number	:	917-841-4142
Fax Number	:

Provider Business Practice Location Address
First Line	:	257 15TH ST APT 203
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-8701
Country	:	US
Telephone Number	:	917-841-4142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/12/2012

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