Provider Demographics
NPI:1548560774
Name:DEGORTER, LORRAINE MARY (S-LP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARY
Last Name:DEGORTER
Suffix:
Gender:F
Credentials:S-LP
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:MARY
Other - Last Name:DEGORTER-LAPOLLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:S-LP
Mailing Address - Street 1:15711 101ST ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3205
Mailing Address - Country:US
Mailing Address - Phone:718-702-8652
Mailing Address - Fax:
Practice Address - Street 1:2534 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3702
Practice Address - Country:US
Practice Address - Phone:718-777-5243
Practice Address - Fax:718-777-5250
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist