Provider Demographics
NPI:1386814119
Name:CONFORTI, LOREBETH
Entity Type:Individual
Prefix:MRS
First Name:LOREBETH
Middle Name:
Last Name:CONFORTI
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 1:208 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1842
Mailing Address - Country:US
Mailing Address - Phone:847-844-8804
Mailing Address - Fax:
Practice Address - Street 1:208 HILLTOP LN
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:IL
Practice Address - Zip Code:60118-1842
Practice Address - Country:US
Practice Address - Phone:847-844-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC516-5206-3958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist