Provider Demographics
NPI:1609401249
Name:LOFARO, AMELIA HART
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:HART
Last Name:LOFARO
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 1:555 WASHINGTON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5946
Mailing Address - Country:US
Mailing Address - Phone:781-237-1735
Mailing Address - Fax:
Practice Address - Street 1:555 WASHINGTON ST STE 5
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5946
Practice Address - Country:US
Practice Address - Phone:781-237-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical