Provider Demographics
NPI:1740866706
Name:AMICO, LORI A
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:AMICO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 RESERVOIR ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3253
Mailing Address - Country:US
Mailing Address - Phone:857-251-7749
Mailing Address - Fax:
Practice Address - Street 1:10 GILL ST STE J
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:617-505-6183
Practice Address - Fax:617-505-6184
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician