Provider Demographics
NPI:1285027318
Name:ZAMUDIO, LORRAINE
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:ZAMUDIO
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 1:1205 E PITTSTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:ME
Mailing Address - Zip Code:04345-5720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5742
Practice Address - Country:US
Practice Address - Phone:270-624-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPSYPAS00193418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist