Provider Demographics
NPI:1407403546
Name:SIMONETTI, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SIMONETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 OAKWOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3603
Mailing Address - Country:US
Mailing Address - Phone:631-766-1887
Mailing Address - Fax:
Practice Address - Street 1:2 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3064
Practice Address - Country:US
Practice Address - Phone:516-758-4121
Practice Address - Fax:516-548-1639
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst