Provider Demographics
NPI:1629085097
Name:CONNORS, LORI LYNN (PSYD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:CONNORS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:BENESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-856-0732
Mailing Address - Fax:508-425-5126
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-856-0732
Practice Address - Fax:508-425-5126
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACOW51098Medicare ID - Type Unspecified