Provider Demographics
NPI:1326132424
Name:LESSIN, LORI (PHD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LESSIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ROUTE 88
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:732-606-1090
Mailing Address - Fax:732-606-1093
Practice Address - Street 1:220 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2531
Practice Address - Country:US
Practice Address - Phone:732-606-1090
Practice Address - Fax:732-606-1093
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3814103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00162141Medicaid
NJ077088Medicare ID - Type Unspecified