Provider Demographics
NPI:1144686700
Name:CONGDON, LORRAINE M (APRN)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:CONGDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:487 S BROADWAY # 220
Mailing Address - Street 2:C/O WJCS
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3269
Mailing Address - Country:US
Mailing Address - Phone:914-423-4433
Mailing Address - Fax:914-423-9434
Practice Address - Street 1:487 S BROADWAY # 220
Practice Address - Street 2:C/O WJCS
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3269
Practice Address - Country:US
Practice Address - Phone:914-423-4433
Practice Address - Fax:914-423-9434
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6465363LP0808X
NYF401878363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004041000Medicaid
CT008003745Medicaid
CT004217099Medicaid