Provider Demographics
NPI:1700039179
Name:FOTOVICH, LORI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:FOTOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:FOTOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:66 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5606
Practice Address - Country:US
Practice Address - Phone:845-245-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0773911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical