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NPI Code Detail

MEDICARE: LOREN DENT PHD

MEDICARE:   LOREN  DENT  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
1103TC0700XClinical Psychologist021744NY

General Provider Information

NPI Number : 1770037152
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOREN DENT PHD
Provider Business Mailing Address
First Line : 623 WASHINGTON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11238-3624
Country : US
Telephone Number : 646-305-6156
Fax Number :
Provider Business Practice Location Address
First Line : 623 WASHINGTON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11238-3624
Country : US
Telephone Number : 646-305-6156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2016
Last Update Date : 08/15/2016

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Directions to “ LOREN DENT PHD” Practice Location

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