Provider Demographics
NPI:1093056418
Name:LORBERT, GUY (HIS)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:LORBERT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 EDWIN RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2400
Mailing Address - Country:US
Mailing Address - Phone:860-745-7701
Mailing Address - Fax:
Practice Address - Street 1:2550 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1936
Practice Address - Country:US
Practice Address - Phone:860-246-7964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT419237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist