Provider Demographics
NPI:1023440419
Name:DR LORI NAUGHTON PSY D PC
Entity type:Organization
Organization Name:DR LORI NAUGHTON PSY D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:517-676-9788
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:517-676-3438
Practice Address - Street 1:1745 HAMILTON RD
Practice Address - Street 2:#325
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1954
Practice Address - Country:US
Practice Address - Phone:517-676-9788
Practice Address - Fax:517-676-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010698103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5530Medicare PIN