MEDICARE: LORI A. URBAN PSY.D., HSPP

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	0810005161	VA
2	103TC0700X	Clinical Psychologist	0810005161	VA

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	:	1467457739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI A. URBAN PSY.D., HSPP

Provider Business Mailing Address
First Line	:	PO BOX 9007
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22906-9007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 RAY C HUNT DR STE 316
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-2981
Country	:	US
Telephone Number	:	434-243-5676
Fax Number	:	434-243-5689

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/10/2023

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