Provider Demographics
NPI:1588796759
Name:DRITZ, LORI A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:DRITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLEVELAND DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6001
Mailing Address - Country:US
Mailing Address - Phone:845-298-0264
Mailing Address - Fax:
Practice Address - Street 1:21 FAIRMONT AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2409
Practice Address - Country:US
Practice Address - Phone:845-452-4030
Practice Address - Fax:845-297-0224
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031263-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN80701Medicare ID - Type Unspecified