Provider Demographics
NPI:1225413859
Name:NEJAIME, LORRAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:NEJAIME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:NEJAIME-DE LOOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:117 APTER DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-5762
Mailing Address - Country:US
Mailing Address - Phone:860-482-6698
Mailing Address - Fax:
Practice Address - Street 1:117 APTER DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5762
Practice Address - Country:US
Practice Address - Phone:860-482-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist