Provider Demographics
NPI:1598374571
Name:LURIE, ALLISON (PSYD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LURIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 TOWN RDG
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1638
Mailing Address - Country:US
Mailing Address - Phone:603-236-6804
Mailing Address - Fax:
Practice Address - Street 1:25 BIRCH ST
Practice Address - Street 2:BUILDING A SUITE A6
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist