Provider Demographics
NPI:1285201541
Name:LORA, BERNADETTE MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARIE
Last Name:LORA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5023
Mailing Address - Country:US
Mailing Address - Phone:191-796-9768
Mailing Address - Fax:
Practice Address - Street 1:105 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5023
Practice Address - Country:US
Practice Address - Phone:917-969-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program