Provider Demographics
NPI:1245407139
Name:CARR, LORA (MS, CCC-SLP, SBL)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:MS, CCC-SLP, SBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 RIDGE BLVD APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5819
Mailing Address - Country:US
Mailing Address - Phone:718-288-9021
Mailing Address - Fax:
Practice Address - Street 1:388 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4820
Practice Address - Country:US
Practice Address - Phone:718-288-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015938-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist