Provider Demographics
NPI:1659017903
Name:FROME, LORI RENEE (MED, LBS, BCBA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:RENEE
Last Name:FROME
Suffix:
Gender:F
Credentials:MED, LBS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 TROY RD
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-9743
Mailing Address - Country:US
Mailing Address - Phone:443-866-3383
Mailing Address - Fax:
Practice Address - Street 1:276 TROY RD
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9743
Practice Address - Country:US
Practice Address - Phone:443-866-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005928103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH005928OtherSTATE LICENSE
15726862OtherCAQH ID