Provider Demographics
NPI:1932155108
Name:CARLEO, LORRAINE I (NP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:I
Last Name:CARLEO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 PORTER ST NW
Mailing Address - Street 2:APT 201
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2951
Mailing Address - Country:US
Mailing Address - Phone:315-717-8012
Mailing Address - Fax:
Practice Address - Street 1:4115 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 107
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2812
Practice Address - Country:US
Practice Address - Phone:202-557-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400646363LP0808X
DCRN1015417363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP69982Medicare UPIN
NYP69982Medicare UPIN