Provider Demographics
NPI:1295092641
Name:AZZARA, LORI ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:ELIZABETH
Last Name:AZZARA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:20 ROCHE BROTHERS WAY
Mailing Address - Street 2:SUITE 6-245
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1030
Mailing Address - Country:US
Mailing Address - Phone:508-930-3553
Mailing Address - Fax:877-509-2367
Practice Address - Street 1:7 CABOT PL
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4631
Practice Address - Country:US
Practice Address - Phone:508-930-3553
Practice Address - Fax:877-509-2367
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA9436103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist