Provider Demographics
NPI:1760829022
Name:KOSTAS, LORI LYN (ASSOCIATES)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYN
Last Name:KOSTAS
Suffix:
Gender:F
Credentials:ASSOCIATES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-2003
Mailing Address - Country:US
Mailing Address - Phone:505-638-6010
Mailing Address - Fax:508-638-6050
Practice Address - Street 1:20 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7122
Practice Address - Country:US
Practice Address - Phone:508-638-6010
Practice Address - Fax:508-638-6050
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)