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NPI Code Detail

MEDICARE: LORI REEVE-DOMENY PH.D.

MEDICARE: LORI REEVE-DOMENY PH.D.
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 Psychologist012172NY

General Provider Information

NPI Number : 1780636654
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI REEVE-DOMENY PH.D.
Provider Business Mailing Address
First Line : 1 OLD COUNTRY RD
Second Line : SUITE 271
City : CARLE PLACE
State : NY
Zip : 11514-1801
Country : US
Telephone Number : 800-725-6280
Fax Number : 800-725-6380
Provider Business Practice Location Address
First Line : 1440 PORT WASHINGTON BLVD
Second Line :
City : PORT WASHINGTON
State : NY
Zip : 11050-2412
Country : US
Telephone Number : 516-719-9400
Fax Number : 516-944-8518
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/08/2007

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