Provider Demographics
NPI:1740776830
Name:ULRICH, LORA ANNE BUCK (MSED)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:ANNE BUCK
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:LORA
Other - Middle Name:ANNE
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2616
Mailing Address - Country:US
Mailing Address - Phone:516-581-3099
Mailing Address - Fax:
Practice Address - Street 1:1005 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2616
Practice Address - Country:US
Practice Address - Phone:516-581-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)