Provider Demographics
NPI:1114216488
Name:LORA, EMMANUEL ANTONIO
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ANTONIO
Last Name:LORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARYLAND CIR APT 218
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-6351
Mailing Address - Country:US
Mailing Address - Phone:610-821-6934
Mailing Address - Fax:
Practice Address - Street 1:19 E ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6520
Practice Address - Country:US
Practice Address - Phone:610-865-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YMO800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health