MEDICARE: LORI LESSIN PHD

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	103T00000X	Psychologist	3814	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326132424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LESSIN PHD

Provider Business Mailing Address
First Line	:	1608 ROUTE 88
Second Line	:	SUITE 203
City	:	BRICK
State	:	NJ
Zip	:	08724-3009
Country	:	US
Telephone Number	:	732-606-1090
Fax Number	:	732-606-1093

Provider Business Practice Location Address
First Line	:	220 RIVERSIDE DR
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-2531
Country	:	US
Telephone Number	:	732-606-1090
Fax Number	:	732-606-1093

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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Directions to “ LORI LESSIN PHD” Practice Location

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