Provider Demographics
NPI:1811002157
Name:JOHN EDWARD LAMOTHE PHD PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:JOHN EDWARD LAMOTHE PHD PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LAMOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-227-6918
Mailing Address - Street 1:124 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5866
Mailing Address - Country:US
Mailing Address - Phone:845-227-6918
Mailing Address - Fax:845-227-4835
Practice Address - Street 1:124 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-5866
Practice Address - Country:US
Practice Address - Phone:845-227-6918
Practice Address - Fax:845-227-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010594-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV44081Medicare UPIN