Provider Demographics
NPI:1407933252
Name:LERTORA, HUMBERT JOSEPH III (LPC)
Entity Type:Individual
Prefix:MR
First Name:HUMBERT
Middle Name:JOSEPH
Last Name:LERTORA
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BRAMBLETON AVE
Mailing Address - Street 2:SUITE B-115
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6515
Mailing Address - Country:US
Mailing Address - Phone:540-725-7774
Mailing Address - Fax:540-725-7774
Practice Address - Street 1:3433 BRAMBLETON AVE
Practice Address - Street 2:SUITE B-115
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6515
Practice Address - Country:US
Practice Address - Phone:540-725-7774
Practice Address - Fax:540-725-7774
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA181358OtherANTHEM