Provider Demographics
NPI:1568522613
Name:VESTRIS, LORRAINE J (LACSW CPP)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:J
Last Name:VESTRIS
Suffix:
Gender:F
Credentials:LACSW CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 78TH ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1222
Mailing Address - Country:US
Mailing Address - Phone:212-288-8159
Mailing Address - Fax:212-452-1525
Practice Address - Street 1:223 E 78TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1222
Practice Address - Country:US
Practice Address - Phone:212-288-8159
Practice Address - Fax:212-452-1525
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03386011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N44061Medicare ID - Type Unspecified
N44061Medicare UPIN