MEDICARE: JOHN EDWARD LAMOTHE PHD PSYCHOLOGIST PC

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	103TC0700X	Clinical Psychologist	010594-1	NY

General Provider Information

NPI Number	:	1811002157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN EDWARD LAMOTHE PHD PSYCHOLOGIST PC

Provider Business Mailing Address
First Line	:	124 DAKOTA DR
Second Line	:
City	:	HOPEWELL JCT
State	:	NY
Zip	:	12533-5866
Country	:	US
Telephone Number	:	845-227-6918
Fax Number	:	845-227-4835

Provider Business Practice Location Address
First Line	:	124 DAKOTA DR
Second Line	:
City	:	HOPEWELL JCT
State	:	NY
Zip	:	12533-5866
Country	:	US
Telephone Number	:	845-227-6918
Fax Number	:	845-227-4835

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN EDWARD LAMOTHE
Credential	:	PH.D.
Telephone Number	:	845-227-6918

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	01/04/2013

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