Provider Demographics
NPI:1164763454
Name:LORDI, TARYN ROSE
Entity Type:Individual
Prefix:MISS
First Name:TARYN
Middle Name:ROSE
Last Name:LORDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1810
Mailing Address - Country:US
Mailing Address - Phone:617-966-3361
Mailing Address - Fax:
Practice Address - Street 1:18 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1810
Practice Address - Country:US
Practice Address - Phone:617-966-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS62550746OtherRMV