Provider Demographics
NPI:1205596798
Name:MACK, LORRI (NBC-HWC)
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WARNER RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-1155
Mailing Address - Country:US
Mailing Address - Phone:617-645-2167
Mailing Address - Fax:
Practice Address - Street 1:20 WARNER RD
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469-1155
Practice Address - Country:US
Practice Address - Phone:617-645-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3489026171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach